The Quality Gaps in the University of California: San Diego Medical School - Case Study Example

Terry D. Edwards U10a1 Project – Final Capella 16 September Leadership is a fixture within every organization but the lack of proper leadership can become problematic within. University of California-San Diego Medical School is an example of leadership in need of improvement. In order to enhance organizational performance, strategies for improvement should be addressed and within this paper, the illustration of performance appraisal, total quality management and continuous improvement strategies will be evaluated. Table of Contents Introduction………………………………………………………………….. 1 Organizational Assessment………………………………………………... 1 Criteria for Organizational Performance………………………………….. 2 Quality Gaps in the UCSD Medical School………………………………. 3 Leadership…………………………………………………………… 3 Management Styles…………………………………………..4 Communication……………………………………………………… 6 Communication Styles…………………………………….....6 Staff Focus……………………………………………………………8 Quality Management ………………………………………………………. .9 Total Quality Management………………………………………….10 Continuous Improvement…………………………………………………...11 Conclusion…………………………………………………………………... 15 Reference…………………………………………………………………….16 Introduction Organizational assessment is the key to effective documentation and measurement of quality and performance for a given organization. Several criteria exist for optimizing organizational performance, and these criteria are also important in organizational assessment. This paper will seek to identify and analyze the quality gaps that exist in the University of California - San Diego Medical School through performance enhancement criteria, and then proceed to discuss concepts of performance excellence, continuous quality improvement and total quality management and how they apply to UCSD Medical School. The role of the leadership in UCSD Medical School in fostering and sustaining organizational and clinical quality will also be studied. Organizational Assessment Organizational assessment allows businesses to determine their current state in terms of quality and performance and as a result formulate policies and strategies for the way forward (Perkins, Verladi, Nightingale and Rifkin p. 1). The initial assessment is important in the identification of performance gaps within an organization and hence an indicator of the areas that should receive priority. After undertaking a transformational path, organizational assessment is important in appraisal of the progress made in the achievement of the desired performance. As opposed to traditional departmental or group performance assessment, organizational performance involves a study of the wide structural and functional aspects of an organization which enable such an organization to develop and implement policies that are sustainable in the achievement of both long term and short term goals. Organizational assessment is a holistic strategy for examining the strengths and weaknesses of the programs being implemented in an organization, and besides this internal perspective, it can also serve as a measure of an organization’s performance against its competitors (Perkins et al. p. 2). Criteria for Organizational Performance The criteria utilized to enhance organizational performance are also the same ones used in organizational assessment. For a health institution such as the UCSD Medical School, these criteria serve to raise organizational performance strategies and capabilities, while at the same time playing a key role in guiding plans and training of staff. Healthcare performance criteria include leadership, staff focus, patient focus, information and analysis, strategic planning, process management and performance results (Hertz, p. 2). Visionary leadership is an important criterion for performance in healthcare as it directs all the other performance criteria and determines the direction of the organization in terms of quality service provision. Visionary leadership balances patient focus and organizational values and objectives with the concerns of all the relevant stakeholders in a bid to achieve excellent services in healthcare. Failure to achieve this is a good indication of the level of performance excellence, hence leadership is integral in organizational assessment. Patient focus is the other center of attraction for both performance enhancement and appraisal, as satisfied patients indicate that the institution is able to achieve its primary goal of providing quality healthcare. Staff focus is also important in achieving quality performance, with evidence suggesting that a workforce that is satisfied with the direction being taken by the institution is more versatile, knowledgeable, innovative and motivated. Thus, satisfaction and development of an institution’s workforce can be applied in its assessment. Ultimately, all the actions above as performed by the institution’s management are directed towards organizational performance; an institution either gets these actions wrong or right, hence they are usually used as the yardstick for measuring organizational performance (Hertz, p. 5-7). Quality Gaps in the UCSD Medical School The quality gaps in USCD Medical School can be studied through covering the areas addressed in the Baldrige criteria for performance. Leadership, communication and staff focus will be the primary focus on this project. Total quality management and continuous improvement are prescribed amongst other strategies of overcoming these quality gaps in the UCSD Medical School. Leadership Within University of California- San Diego Medical School, leadership is perceived to be lacking or nonexistent from a number of those responsible. Without proper leadership, the atmosphere and morale within the unit will be on a continual decline. Within the military, leaders are in place to train a new leader and within business; the means for teaching of leadership is no different. Some individuals with leadership potential are given assignments in which senior leaders can observe them directly and meet with them individually to get to know them better. The senior leaders’ insights become part of each individual’s personalized development plan (Charan, 2008). Currently within the division of medical education at the medical school, the leadership has not illustrated enough focus on the staff to energize or influence their production. Influence is the active relationship among people; however, also inherent in this definition is the concept that influence is multidirectional and non-coercive (Draft and Lane, 2008). Departments are usually put together to run as a unit in order to get the job done, but the current means of getting that done is illustrated through the leadership within these departments. The means of how one leads can also become a problem, especially if that management style is one that micro manages their employees. Micromanaging is a management style in which a supervisor closely observes or controls the work of an employee. In contrast to giving general instructions on smaller tasks while supervising larger concerns, the micromanager monitors and assesses every step. This behavior adversely affects supervisor–employee communication, creativity, productivity, problem-solving, flexibility, trust, feedback, openness, and company growth and goal attainment (Fracaro, 2007). Management Styles The situation on leadership above necessitates that the UCSD School of Medicine should undertake a careful review of its management structures and styles and change it as necessary. The management styles undertaken by the leadership in an organization such as UCSD Medical School goes a long way in determination of organizational performance. A management style is basically the chosen approach in provision of direction, policy implementation and staff motivation. Muller, Jooste, and Bezuidenhout (p. 399) identify various types of management styles, how they are undertaken and the response to them by the workforce. Some of the most common styles of management include autocratic, participative, delegative, bureaucratic permissive among others. In the healthcare industry, the top management can usually be seen to practice democratic, bureaucratic, maternal and autocratic forms of management. The democratic or participative manager makes decisions in consultation with the employees and ensures that there suggestions and concerns are considered before implementation of policy (Muller et al., p. 400). In this form of management, the employees clearly understand the organization’s objectives and their roles in achieving these since they take part in decision making. The employees’ response to participative management is voluntarily accepting responsibility, and through teamwork operations can proceed even in the absence of the manager since the remaining employees know their roles and take the initiative to work without supervision. An authoritative manager on the other hand makes independent decisions and implements them on the basis of punitive measures if the set standards are not met. This management style is largely coercive and does not take into consideration the ideas, concerns, opposition or criticism from the employees. There is low incentive for teamwork and initiative taking with responsibility being avoided, and performance is minimal in case of the manager’s absence. A maternal approach to management can also be observed in healthcare especially in nursing, where the leadership oversees all the activities and is involved in every detail of operations not just in a supervisory role but in decision making. The employees develop dependence on the management, lack initiative and imagination and portray poor decision making in the manager’s absence. Bureaucratic managers in contrast are not willing to engage the employees, instead sticking to the duties of administration. The team lacks leadership and none of the employees take responsibility for failure. Decision making is slow and disinterest in service provision is manifest. Achievement of success in the operations of an organization is directly dependent on the management style adopted. To achieve performance excellence, total quality management and continuous improvement, participative management should be practiced in the UCSD Medical School. Communication Communication plays an important part when examining the quality within an organization. In regards to communication, UCSD School of Medicine uses email, telephone, face-to-face, intranet, fax, video conferencing and letters to communicate different instructions to the staff. Verbal communication is a skill that leaders should possess. Current leadership lacks the skill to professionally use verbal communication. The current leadership has the tendency to verbally communicate personal and confidential information within earshot of other employees who should not be privy to that type of information. Email communication provides the bulk on the instructions/communication in and out of the department and this also poses problems including misinterpretation, delayed response and lack of a personal touch. Communication styles As it has already been stated, communication is a major determinant of organizational performance especially for institutions involved in healthcare such as UCSD Medical School. Team communication is crucial for medical practice and should flow effectively both vertically and horizontally (with the management and across the staff). In an institution such as the UCSD Medical School, communication may be hampered due to the difference in communication styles according to professional background; doctors, nurses, human resource managers and staff, hospital managers, finance, inventory and others. This may in turn inhibit service delivery to the patients due to unstructured policy implementation and erosion of teamwork (Jones, p. 86). Communication disconnect occurs along professional lines due to differences in training, values, thinking and interpretation and rules of conduct (Jones, p. 87). Personal attributes also impact communication styles and it is important for the top management to appreciate the different types of communication styles portrayed by the workforce, conduct SWOT analyses and reconcile them for optimum organizational operations (Jones, p. 87). In any organization, communication can be linked to the four behavioral styles that can be demonstrated among the workforce; analyzers, directors, socializers and relators. The analyzers are a particularly thoughtful category, while the directors are action oriented. The socializers are inspirational while the relators are sensitive to fellow staff (Jones, p. 91). Each of these individuals in a setting such as the UCSD Medical School have their own strengths and weaknesses, and achievement of effective communication necessitates that these are analyzed and manipulated to maximize productivity. While an analyzer might appear inflexible, he also portrays thoroughness, logic, preciseness and prudence. Directors may be overbearing and insensitive but their independence, pragmatism, objectivism and efficiency proves beneficial to the organization. The permissiveness of relators may be detrimental to the organization, but their patience, loyalty, cooperation and diplomacy is indispensable in a hospital setting. As for the socializers, UCSD Medical School may benefit from their imagination, enthusiasm and spontaneity but they may also be overambitious and not disciplined. The natures of these individuals impacts their communication, as UCSD Medical School may realize that analyzers prefer orderly communication, directors are more action oriented and thus prefer short speeches, relators are more inclined to comfort and social communication while socializers are impulsive and volatile in communication. These groups also prefer different media for communication, and hence reconciling all of them for optimal organizational operation and performance may seem difficult. However, achieving complementary communication may result in synergy and thus even better communication. Staff Focus One of the issues that face the Division of Medical Education at UCSD School of Medicine is that leadership has shifted the focus of the division. It has moved from one that serviced faculty, students and staff to one of automation, efficiency, and reduction of effort to complete tasks. This shift has been difficult for the employees to adapt to, as it has resulted in a reduction in staff numbers and an increased workload for the remaining staff. In this difficult shift in focus strong leadership is essential. The current leadership has poorly handled this shift leading to low morale and disgruntled employees. The leadership of the division needed to provide employees a clear vision of the direction of the division, and keep employees in the loop as changes and shifts in workload occurred. This information flow should have been with the entire division not just from one manager with a small group of select employees. While the employees of this manager felt in the loop and knew what was happening and the planned shifts all other employees of the division felt out of the loop. This mismanagement led to a division amongst the employees. Those who were ignorant of the changes drifted away from the division and became very distant and disgruntled. Many began to resent the manager responsible for the situation and their fellow employees who were privy to the information. As a result the division has become a place where many of the employees feel trapped, underappreciated, and overworked. With the proper leadership in place and utilizing more transparent techniques the division could have avoided the resentment and low morale that currently are plaguing the division. These issues will again require strong leadership and staff focus to bring the division back together and make it more serviced oriented while utilizing automated processes to increase efficacy. Quality Management According to Kelly, the term “quality management” refers to the manager’s role and contribution to organizational effectiveness (Kelly, p. 11). The effectiveness of management is consistent with the functions of how daily operations commence within. Within UCSD Medical School, leadership has been more of a paper title vice something of action. The actions of leadership have not been directed at attempting to guide those employees under them, which has affected a number of areas within the organization. Total quality is “a philosophy or an approach to management that can be characterized by its principles, practices, and techniques (Kelly, p. 10). Within quality of management and the principles that come along with them, two that should be a focus within this organization are continuous improvement and teamwork. The principles of continuous improvement may also be expressed through managers’ execution of their managerial functions (Kelly, p. 26). Managerial functions are to lead instead of dictate and in order to shift the attitude or productivity within an organization, leadership within UCSD Medical School should examine the types of leadership styles that could help change the environment. Leadership occurs among people; it is not something done to people (Draft and Lane, p. 5). By examining the current environment, managers should illustrate that they are showing initiative in order to change the current environment. Demonstration of the initiative for change enables the concept of teamwork to come into play, but only if the leadership works with their employees. In many organizations, when the terms “teamwork” and “quality” are used together, they usually refer to cross-functional or interdisciplinary project teams (Kelly, p. 27). Within the project teams, Lean Six Sigma could be utilized when an organization is looking to improve the quality of their operations and management. Executives want to learn Lean Six Sigma to improve the bottom line of their organization, as well as to improve their professional skill set and effectiveness on the job (Gitlow, p. XII). Lean Six Sigma gives managers the opportunity to examine management and how things are running within. Managers will find the following common steps in these techniques; systematically identifying causes of problems, designing and implementing improvements, and monitoring and continually improving the effects of the intervention (Kelly, p. 41). Total Quality Management Organizations around the world have come to appreciate the concept of total quality management, an approach that seeks to arrive at sustainable long term success for the organization through involvement of the employee in operations, customer satisfaction, and conforming to societal values and government regulations (Charantimath, p. 6). Adoption of total quality management in UCSD Medical School is a sure way of achieving both internal (workforce) and external (patients and partners) satisfaction through creation of an organizational culture that allows for continuous improvement with regards to all the operations within an organization. It is a never ending undertaking that also serves to create sustainable competitive advantage. The concept of total quality management is anchored on a number of ideas; to begin with, quality ultimately pays for itself through reduction of costs and increased sales. For the UCSD Medical School, this can be translated to mean that reduced wastage and patient satisfaction cover any costs incurred in implementing total quality control. “Zero defects” is a core concept in total quality management centered on prevention of errors. Adoption of best practice and error elimination alongside adept measurement practices in a healthcare institution such as UCSD Medical School are central to achievement of total quality control. A total quality management model covers several areas of the organization’s operations; the corporate policy implemented, the type of organizational management in place, the presence and effectiveness of staff development through education and training, implementation of quality management systems, information collection and analysis procedures, standardization of operations, quality control and finally quality assurance. Continuous Improvement The ideas of quality management have been addressed but in order for it to be successful, continuous improvements must be implemented. In the Deming management method, Visionary Leadership, Learning, Process Management, Continuous Improvement and Customer Satisfaction are a number of areas that can be addressed within UCSD Medical School. Leadership is a key aspect in order to continue with improvements within any organization. It involves the ability of management to establish, practice, and lead a long-term vision for the organization, driven by changing customer requirements, as opposed to an internal management control role (Douglas & Fredendall, p. 395). Once the quality within the management has been addressed, the long-term vision of an organization is something that has to continue to be followed in order to make sure the organization is headed in the right direction. Several health care articles address the importance of visionary leadership in quality program implementation (e.g., Arndt & Bigelow, 1995; Bender & Krasnick, 1995; Guq & Martin, 2000; Motwani, Sower, & Brashier, 1996; cited in Douglas & Fredendall, p. 396). The importance of continuous improvement in all aspects of an organization’s operations cannot be overstated, allowing the organization to achieve the desired satisfaction of customers at minimal costs irrespective of whether such an organization is public, private or even voluntary (Marsh, p.9). The success of an organization such as the UCSD Medical School stems from the impact it has on customers; the patients. Continuously satisfied patients spread the message about the medical school to their friends and as a result a ripple effect of customer attraction is achieved. When a company achieves customer satisfaction and people satisfaction, it is able to influence how the community around it perceives its operations. It has been shown that successful organizations invest in the local community and thus have a good public image, and the ultimate result is that continuous improvement leads to an impact on the society (Marsh, p. 10). A model for business excellence based on continuous improvement has clear definitions of leadership, processes and business results. The leadership aspect of the UCSD Medical School should impact on people management (doctors, nurses, and supportive staff), policies and strategies and resources to form processes that result in satisfaction of both the staff and the patients alongside achieving wider societal impact, which inevitably creates business results. Application of this to the UCSD Medical School implies that continuous improvement would lead to better patient care that would result in their satisfaction. Such a scenario would then lead to a better societal reputation as the institution of choice within the locality and even farther in terms of healthcare provision. Obloj, Cushman and Kozminsk (1-2) also add to the evidence on the importance of continuous improvement based on changes in the environment by making the observation that the main difference between successful and unsuccessful organizations is their ability to adapt environmental dynamics. For the UCSD Medical School to achieve better healthcare provision and customer satisfaction, it is imperative that continuous improvement be implemented. Effective continuous improvement depends to a large extent on the strategy of implementation. Larson (3) undertook to explain the widely successful Six Sigma model that informed navy operations especially during the cold war and how they could be applied in organizations. He demonstrates an analogy between a navy submarine unit and any organization and shows how Six Sigma can be utilized successfully to achieve continuous improvement. In a similar fashion to a submarine, an organization such as the UCSD Medical School has a hierarchy of command from senior management to junior staff; diversity in workforce in terms different education levels and expertise among the doctors who are also specialized in different medical fields, nurses, supportive staff; and a workforce consisting of qualified individuals who have been sufficiently trained to handle their job description. The analogy also extends to what happens in case the workforce of the UCSD Medical School fails to realize that it is a team; just like a submarine would be sank, USCD Medical School would also fail. The Six Sigma culture can be utilized to achieve continuous improvement resulting from an internal culture that ensures that the employees are aware of the fact that each of them is part of a collective whole, and how their job roles contribute to organizational success in terms of quality patient care and satisfaction. A culture of mutual respect for each other and unity of purpose is the key to implementing successful continuous improvement. Six Sigma is a method which can be implemented successfully at the UCSD Medical School, with the only requirement being the leaders’ ability to motivate the workforce to adopt it wholly. The tenets of Six Sigma include rewarding and recognizing accomplishments, undertaking training for all the staff, measurement that is uniform in terms of specific job roles-both medical and nonmedical, facilitation for example through the human resource department of the UCSD Medical School, effective communication of expectations and roles of each team player, and finally leadership that shows commitment to Six Sigma (Larson, p. 17-18). Structured appraisal of this model and undertaking the necessary interventions results in continuous improvement. In order to successfully implement effective continuous improvement, UCSD Medical School management and the selected facilitators are required to possess sufficient knowledge on it. Obloj et al (p. 22) reckon that a continuous improvement theory has a base of layers; the first one entails the association of an organization’s advantage over competitors, its adaptation to change in the environment and its capacity to learn as time progresses. In the case of UCSD Medical School, this would involve identification of what sets it apart from the rest, alongside adaptation to the emerging issues facing the healthcare sector across the country. Another layer involves the way institution learns from such emerging issues, challenges and strengths in order to place itself in a better position in the future, a scenario which portrays continuous improvement. The second base to continuous improvement for an institution such as UCSD Medical School involves the internal and external resources and capabilities at the organization’s disposal and how the two align them to the organization’s objectives. The management of the UCSD Medical School has to take account of both the human and physical resources it has and how well these can achieve patient satisfaction alongside sustainability. A continuous improvement strategy is doomed if its implementation is unable to optimize capability to use the resources available. The UCSD Medical School management must appreciate three sources of knowledge that inform continuous improvement; professional knowledge, technical knowledge and practical knowledge, all of which play their part in the construction of a continuous improvement theory. Professional knowledge is derived from general education, while technical knowledge is obtained from descriptions of processes. The main contributor to continuous improvement however is practical knowledge as it is directly concerned with the institution’s operations and what works or fails to work (Obioj et al, p. 23-25). It is thus imperative that the top management at the UCSD Medical School build continuous improvement based not just on education and expertise but heavily influenced by the practical aspect of healthcare with patient satisfaction being borne in mind at all times. Conclusion Organizational assessment through performance criteria is crucial in determining the direction the institution is headed, and after implementation of transformational strategy, the assessment is again important in determining whether the intended progress is being achieved. An organizational assessment in the UCSD Medical School reveals that quality gaps are existent in its leadership, communication systems and focus on staff. It is recommended that UCSD Medical School should implement total quality management and continuous improvement which would result in both internal and external satisfaction and competitive advantage in the healthcare industry. The role of leadership in achievement of organizational performance excellence in UCSD Medical School is highlighted since all the other performance criteria largely depend on the leadership’s ability to manage them towards sustainable quality healthcare provision and patient satisfaction. References Charantimath, P.M. (2003). Total Quality Management. Pearson Education, Business & Economics. Retrieved from http://books.google.co.ke/books?id=FW3oHcAwc_0C&dq=total+quality+management&hl=en&source=gbs_navlinks_s on September 15, 2011. Charan, R. (2008). Leaders at All Levels: Deepening Your Talent Pool to Solve the Succession Crisis. John Wiley & Sons, Inc. Retrieved from http://books.google.com/books?id=UDWl_Wx2l5oC&pg=PT2&dq=broken+leadership&hl=en&ei=1wRFTr7cEKjbmAWV-8TUBg&sa=X&oi=book_result&ct=result&resnum=2&ved=0CC4Q6AEwAQ#v=onepage&q=broken%20leadership&f=false on 12 August 2011. Draft, R. L., Lane, P. G. (2008). The leadership experience. Fourth Edition. Thomson South-Western. Retrieved from http://books.google.com/books?id=JJ_HuV1KlyQC&pg=PA3&dq=what+leadership+mean&hl=en&ei=cw1FTvXYM6OfmQWk0MzdBg&sa=X&oi=book_result&ct=result&resnum=6&ved=0CEIQ6AEwBQ#v=onepage&q=what%20leadership%20mean&f=false on 10 August 2011. Douglas, T. J., & Fredendall, L. D. (2004). Evaluating the Deming management model of total quality service. Decision Sciences, 35(3), 393. Fracaro, K. E. (2007). The Consequences of Micromanaging. Are you standing in your own employees’ way? Take a step back so your company can move forward. Retrieved from http://www.ncmahq.org/files/Articles/ECB0A_CM0707_C01.pdf on 12 August 2011. Gitlow, H. S. (2009). A Guide to Lean Six Sigma Management Skills. Auerbach Publications. Retrieved from http://books.google.com/books?id=EkD5wIOZ5DcC&printsec=frontcover&dq=lean+six+sigma+and+management&hl=en&ei=t61vTvqIEIrr0gHq69HoCQ&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDwQ6AEwAQ#v=onepage&q=lean%20six%20sigma%20and%20management&f=false on 13 September 2011. Herltz, H.S. (2000).Health Care Criteria for Performance Excellence: Baldrige National Quality Program. DIANE Publishing, Business & Economics. Retrieved from http://books.google.co.ke/books?id=b_ytRxdldqAC&dq=criteria+to+enhance+organizational+performance&hl=en&source=gbs_navlinks_s on September 15, 2011 Jones, R. (2007). Key Topics in Healthcare Management: Understanding the Big Picture. Radcliffe Publishing Ltd. 86-91. 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The continuous Improvement toolkit: A Practical Resource for Achieving Organizational Excellence. 9-10 Retrieved from http://books.google.com/books?id=rRM_9DVsJvsC&printsec=frontcover&dq=continuous+improvement&hl=en&ei=zXhGTsqpJNDtmAXC4PHlBg&sa=X&oi=book_result&ct=result&resnum=8&ved=0CFEQ6AEwBw#v=onepage&q&f=false on 12 August 2011. Muller, M., Jooste, K., Bezuidenhout, M. (2006). Health Care Service Management. Juta and Co Ltd. Retrieved from http://books.google.com/books?id=Nr0fJGpNYm0C&pg=PA81&dq=management+styles+in+healthcare&hl=en&ei=LmxHTufxDsKEmQXf45X7Bg&sa=X&oi=book_result&ct=result&resnum=10&ved=0CFsQ6AEwCQ#v=onepage&q=management%20styles%20in%20healthcare&f=false on 14 August 2011. Obloj, K., Cushman, D. P., Kozminsk, A. K. (1995). Winning: Continuous Improvement Theory in High-Performance Organizations. State University of New York Press. 1-25 Retrieved from http://books.google.com/books?id=3HNS0eDmF38C&printsec=frontcover&dq=continuous+improvement&hl=en&ei=_35GTsrHOemjmQXT1Jz0Bg&sa=X&oi=book_result&ct=result&resnum=9&ved=0CFYQ6AEwCA#v=onepage&q&f=false on 11 August 2011. Perkins, N. L., et al (2010). Organizational Assessment Models for Enterprise Transformation. INCOSE, USA. Retrieved from http://www.master-systems.com/filecabinet/OrganizationalAssessmentModelsForEnterpriseTransformation.pdf on September 15, 2011 Read More