The Universal Worker: Redesigning the Patient Care Delivery - Essay Example

? The Universal Worker: Redesigning the Patient Care Delivery Number and of Submission (e.g., October 12, 2009) The Universal Worker: Redesigning the Patient Care Delivery Introduction Organizational change is characterized as inevitable and a concurrent necessity. It harnesses both positive and negative effects; either it adds or deducts the workforce, the workload and the work goals. It may also lead to more opportunities aside from threats and may come in the form of improvement, upgrade and re-assessment of existing skills and systems. All of these are dependent to a number of participators, namely: change-recipient, -implementer, -planner, and -administrator. Aside from the organizational sector, other sectors are also at play in the midst of change. They may include the social, economical and the political sectors per levels of community, public or private entities, and the regional and national authorities. Reacting to change was largely partitioned into two: through resistance or allegiance. The health care facility chooses the latter but is not ignoring the existence of the former. Rather, the facility wants to take these two into consideration in redesigning the existing patient care delivery, and understand better and evaluate the feasibility of applying the administration’s recommendation of employing universal workers. After Merge The merge had left the facility with a redundancy of several staff positions; thus, the consequent reduction of workforce. Existing issues had to override with the concern on coping with the loss of compartmentalized service providers. The primary issue involve is the fragmentation of patient care delivery which resulted to poor coordination between service providers within the facility. In a fragmented delivery system, inefficiencies include failure to assist the patients and their families in navigating through the facility’s health care system, lack of service provider-to-patient accountability, absence of feedback collection systems and feedback-based improvement schemes, not systematized clinical records, and higher emphasis on “high-cost, intensive medical intervention” against the “higher-value primary care” (Shih et al., 2008). Furthermore, the patients are well aware of these inefficiencies, having “frequently reported” the several instances of coordination breakdowns (How, Shih, Lau, & Schoen, 2008). Evidently, a fragmented system of delivery is not enough to achieve higher efficiency in delivering health care services. The assessment of the facility’s current system of patient care delivery indicated only one type of work orientation adopted by the service providers -- the task orientation. This task-orientation’s primary merit is its guarantee of high mastery, which is the nature of task-specialization. However, it failed to address the health care facility’s primary aim - not just the proper execution or administer of services, but its appropriate delivery. Service delivery, in general and across other fields, takes not just the task-orientation but also the customer-oriented stance. Narrowing the issues from the identified proper service orientation to the current workforce population, the question now is how to apply customer orientation with the current patient care delivery system that employs fewer hands. The answer heavily lies on the remaining workforce qualification, which was dominantly comprised of highly-specialized service providers who could still accommodate additional task responsibility. The workforce evaluation, which aimed to identify service providers who possess this qualification, is the first step in the process of job redesign. Universal Worker Concept The health care facility is an environment that fosters and encourages the continuum of learning; this learning allows service providers to best serve the varying and differing needs of the patients. The redesign of the patient care delivery should be considered as another aspect of continuum learning. However, this learning will be facility-wide, systematized, and aimed to a customer- or patient-orientation of patient care delivery. The remaining workforce will be trained to acquire and be able to perform more than one task per patient. Particular work processes will be integrated such that instead of the patient having to interact with several compartmentalized service workers to attend to their different needs (e.g., laundry, bathing, eating, etc.), the patient will only interact with 2-3 universal workers that are capable of multi-tasking (Widdes, 1996). This work setting, according to Widdes (1996), has the potential to enhance care, making it “more personalized, customized and consistent.” Furthermore, it promotes higher worker interaction, not just intervention. It also creates per patient system of care delivery, which provides a flexible meeting of service demand-and-provide. This system has the potential of eliminating depression, which patients often experience in having to interact or communicate with a lot of service workers (Gilbody, Bower, Fletcher, Richards, & Sutton, 2006). The universal worker also has the potential of offering higher job satisfaction to service providers. In fact, in Manor Healthcare Arden Courts, staff feedback indicated the fulfillment of “being responsible for the resident ‘as a whole’ rather than for only one aspect of their care” (Widdes, 1996). The higher the interaction between the universal worker and the patient, the higher potential of working with more self-efficacy in a worker’s perspective and more often than not, self-efficacy manifests a healthy working morale. For non-universal working peers, the higher responsibility of a universal worker earns much respect. Furthermore, the level of accountability is much weighted and coordination of information more detailed and uniformed with only few workers (i.e. the universal workers) to interact with. Implementing Guidelines Peter Senge’s five disciplines are instrumental in providing the workforce community the relevant and compact details needed to participate accordingly to this patient care delivery redesign: system thinking, personal mastery, mental models, building shared vision, and team learning. These five highlight the healthcare facility system, the remaining workforce work qualifications, the shared mental models versus the proposed mental models, the consistency of the facility and the workforce vision, and the different team orientation per patient care. The healthcare facility should recognize its workforce as learning players of their learning organization and that organizational learning could only occur through individual learning (Senge, 1990). Systems Thinking. The existing healthcare system should first be re-assessed in each aspect’s perspective: the administration through its studies and evaluation methods; the workforce through feedback instruments such as questionnaires; and the patients through verbal or written feedback. It is important to capture the real picture of the existing patient care delivery; thus, the credibility of these assessments should be highly prioritized. Next, the feedback from these three should be studied and integrated for consistency, exceptions or assumptions to illustrate a non-biased assessment. The final product should be able to pinpoint specific areas of improvement in the existing system’s inefficiencies. The emphasis should be on improvement, not on the inefficiencies; both worker and administration should be responsible enough to accept culpability because blame games only lengthen this process (and the process may just get stuck here). Last is the introduction of the proposed system of universal workers and how it will address the identified improvement points. Personal Mastery. The administration should express its high regard of the existing qualifications of the workforce. However, the identified improvements call for higher efficiency in care delivery that could be best addressed through acquisition of more skills. This acquisition should not be seen as an end in itself but as the continuing search for ways to improve or upgrade the ways of serving the patients. This perspective and encouragement of skill acquisition should be communicated as making the facility a learning organization. The healthcare facility as such should require the administration to simulate an environment that is conducive for learning aside from service-providing while the workforce team is required to get involved and participate in this learning environment. Mental Models. The study of existing systems and workforce qualifications should be able to expose assumptions, follow working codes and other mental pictures that make up the service provider’s mental model. The administration should be careful and sensitive in studying such mental models in cases where in parts of the model are not consistent to the facility’s ideal or tolerated model. The introduction of the redesigned health care facility, with its team of universal and non-universal workers, should identify a simplified per patient serving model that eliminates and adds a part or parts of the existing models. The sensitivity of this intervention should also be prioritized since this entails much effort on the worker’s perspective. It is not enough that the administration acknowledges this effort; the administration should be able to present positive patient feedback out of this effort and/or provide incentive schemes if necessary. Building Shared Vision. The health care facility, specifically its top leaders, must effectively express its commitment to provide efficient, patient care delivery. This can be done through meetings, gatherings, memorandums, etc. To extend these words of commitment to action, the administration will communicate the required effort to achieve an efficient, patient care delivery through adoption of a learning organization stance in putting into application the universal worker system. Aside from specific work requirements, sharing the facility’s vision throughout the workforce should involve effective and consistent feedback of the workforce efforts such as their position or status in the level of improvement/learning, and the administrations’ and patients’ specific feedback. Furthermore, this feedback system should be a cycle that goes back to the top leaders for them to evaluate and communicate to the workforce the per level goal and its impact on the health care facility’s commitment to efficient, patient care delivery. Team Learning. A different team orientation, brought about by the redesign, should also be introduced - a team consisting of universal and non-universal workers. This type of team should not be shown as a restrictive format but a flexible and learning-conducive team that aims to carry out the shared vision through a combination of personal mastery. Learning by team involves higher levels of effective communication, as well as coordination per task and per patient information. Team learning should also be able to visualize its position in the overall commitment of efficient, patient care delivery to attain consistent yet flexible participation. This redesign entails management of intra-organizational and inter-organizational communications to make sure that the information flow is not detrimental to the application of the proposed system yet not biased at the same time. Information control should involve feedback filter, which works through choosing of the appropriate sector recipient of the facility. This communication control should also look into consideration the manner of disseminating and the language format, whether it is written or verbal, which has to be informative yet concise for each of the required recipient to be able to understand, remember and realistically apply it to their individual and team tasks. Conclusion The inefficiency of the existing patient care delivery and the number of the remaining workforce had resulted to substantial redesign of the healthcare facility’s service system. While the universal worker system addresses these two, the facility furthers the effort of enhancing the delivery system through the long term approach of a learning organization. The combined service redesign and extension of organization sphere calls for a re-assessment of existing systems, re-evaluation of workforce qualifications and development of appropriate improvements thereafter. To be able to mobilize all of these changes, the facility, the workforce and the patients are encouraged to open up and participate. A great deal of change and willingness to change from individual-to-team and workforce-to-administration are required to achieve the shared vision which is to improve the healthcare facility’s patient care delivery. References Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006). Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine, 166, 2314-2321. How, S. K. H., Shih, A., Lau, J., & Schoen, C. (2008). Public views on U.S. health system organization: A call for new directions. New York, NY: The Commonwealth Fund Commission. Senge, P. M. (1990). The fifth discipline: The art and practice of the learning organization. New York, NY: Random House. Shih, A., Davis K., Schoenbaum, S. C., Gauthier, A., Nuzum, R. & McCarthy, D. (2008). Organizing the U.S. health care delivery system for high performance. New York, NY: The Commonwealth Fund Commission. Widdes, T. (1996, April). Assisted living's universal worker. Nursing Homes. Retrieved from http://findarticles.com/ Read More