24 Mar Creating Change in the Midst of Chaos
Case Study 2-1 Creating Change in the Midst of Chaos
Nancy has been the CNO at Shady Point Hospital for 15 years, but this last year has been the most difficult for her. It seems as if there has been one change after another this year, and Nancy is tired of trying to lead the nursing staff through the changes, making sure the physicians are satisfied, and ensuring that the patients receive the best possible care. It seems that the staff are fatigued with all the changes and meetings as well, and some have said, “We just want to be nurses and take care of patients.” It was easier in the past—the hierarchy and structure of the hospital seemed to provide some stability. Nurses were content to work at Shady Point for their entire careers, and nearly 50% of the nurses had been there 15 years or longer. Some of the nurses actually had trained at Shady Point’s nursing school, a diploma school that closed 25 years ago.
Feeling the pressure from other hospitals’ CNOs in the Northwest Healthcare System, Nancy has been investigating what it will take to commence the Magnet journey. In preparation, she has hired a director of professional development and research who has a doctoral degree from a respected university. Although it seemed like a great idea in the beginning, she notices now that the nonproductive education hours are completely over budget and the CFO is pressuring her to correct the problem. The new director of professional development is encouraging the nurses to develop career plans, return to school, and to become certified. Now, many of the nurses who feel like they should return to school to get a bachelor’s degree or certified in their specialty are demanding more support for tuition reimbursement, increased pay after they obtain their specialty education, and some paid hours for attending classes. Nancy is overwhelmed with all the demands and changes and the pressures she feels from the rest of the executive team to stay in budget and to improve the nurses’ satisfaction levels. The entire organization seems to be in a state of chaos under demands to reduce operating expenses while the staff and physicians are demanding more and more. Nancy typically holds things “pretty close to her chest” and tries to manage the nursing department on her own without sharing many of the details with her team of directors.
At wit’s end, Nancy seeks the counsel of a colleague in a neighboring state who has led his hospital through complex times and even led the nursing staff to Magnet designation. He advises her to reach out to her colleagues on the executive team because the nursing department is core to the business of the hospital. He thinks that she needs to create a shared sense of responsibility for the changes that are occurring in the hospital and in nursing and to work toward a better understanding of how a satisfied nursing staff influences patient outcomes, physician satisfaction, and departmental relationships. He also advises her to develop her own directors to work together as a high-performing team and to be more transparent about the pressures she feels to meet operating targets. They talk about her adjusting her own attitude to the job with a goal of creating new mental models about the demands. Perhaps she could consider them more as challenges that need to be solved rather than impossible situations.
Just talking about all that she has faced seems cathartic and speaking out loud about the problems seems to give her new direction. She realizes that some people would have simply entered into her negative feelings and either advised her to seek a different job or pitied her situation. Nancy is grateful for her colleague’s honesty, and she tells him how much she appreciates his boldness and encouragement of her reaching her full potential. They agree that she will keep in touch with him and that he will mentor her over the next few months. She takes some time off to relax and think things through, and she is actually surprised to feel excited to return to work again.
Nancy arrives at work with a new sense of commitment and resolve. She calls together the directors of the various nursing departments and the director of professional development and research and talks with them about her vision to transform the nursing division. She shares her concern that obtaining Magnet designation will be a huge challenge in the economic climate of the hospital. She is very frank with the directors about all that needs to occur and asks them to join her in this endeavor. Some of the directors are very excited about the possibilities of changes in organizational structure, advancement of the staff capabilities, and transformation of the organization to a high-performing one. Nancy asks the director of professional development and research to do a gap analysis of the organization’s current capabilities in comparison to the Magnet requirements. She also asks that the directors work together as a team to identify strong nurse leaders among the staff who can compose a new Magnet steering committee. Nancy shares her vision that the Magnet steering committee should design the collaborative governance structure for the nursing division, and that the directors should act in roles as consultants instead of designing the structure themselves. The director group soon realizes that Nancy’s style of leadership has changed dramatically since her vacation, and they are excited and uneasy about the changes she outlines.
Nancy also meets individually with the COO, CFO, and her CEO to share her concerns about the across-the-board budget cuts that negatively affect the nursing division and, ultimately, patient-care quality. She shares a plan of how to reduce expenses while preserving the professional role of the nurse as the team leader in the planning and implementation of patient care. She tries to develop a shared vision among her colleagues so they will be invested in her plan to develop and advance the nursing division but also see her as responsible and accountable for the financial integrity of the overall organization. Nancy also meets with the other divisional leaders to discuss how their roles intersect in meeting the organization’s goals and financial targets.
As part of the transformation of the nursing division, Nancy works with her direct reports to discuss different leadership styles and leadership theories. She introduces them to concepts such as the servant leader, transformational leadership, and motivation and change theories. She recommends that the directors who do not have master’s degrees in nursing leadership consider returning to school, and she offers them one day off per week to attend classes. She still expects them to meet their productivity and financial targets and other quality indicators, but she sees the potential in each individual and is confident that the directors will be able to accomplish their roles at the hospital and their new student roles. All the while she is speaking, she is constantly observing the directors’ body language, facial expressions, and reactions to her thoughts on expanding their knowledge, skills, and capabilities in leading high-performing teams. Although she realizes that there is some risk in asking her direct reports to return to school while working full-time, she is confident that their exposure to new knowledge will also expand their success at work. She reassures them and lets them know that she is available at any time to talk with them about their fears and concerns. She also encourages them, and particularly the director of professional development research to motivate the staff nurses with diploma and associate degrees, to also continue their education toward the bachelor’s degree. Nancy indicates that she is in negotiation with one of the local universities to provide some of the education on site at the hospital to facilitate the nursing staff and directors furthering their education. She shares that she is also working with Human Resources, her executive colleagues, and the Shady Point Foundation to develop nursing scholarships and tuition reimbursement up to $1,000 per person per year.
After a few months, Nancy reflects on all the changes that are occurring at Shady Point Hospital and the pressures she continues to feel to be a good steward of the hospital’s resources. She feels excited about the transformation she is witnessing in her directors and the staff as a whole. She also feels more connected with other divisional leaders and the executive team, and although they don’t always agree on solutions to problems, they do agree to work as a team to accomplish their shared goals. Changes are coming fast, but Nancy has found strength within herself and her director team that she never dreamed possible.
Questions
1) Who are the stakeholders in this case? Analyze the case by taking on the role and perspective of each stakeholder.
2) How can Nancy possibly lead Shady Point to thrive in the face of the organizational chaos and complexity?
3) What strategies would you use to prepare the nursing team for a Magnet application?
4) What should Nancy do to sustain the gains she has seen in teams at Shady Point?
5) What strategies can a leader employ to create a shared vision?
INSTRUCTIONS:
• PLEASE READ ABOVE CASE STUDY AND ANSWER THE 5 QUESTIONS THAT FOLLOWS.
• REFENCES CANNOT BE MORE THAN FIVE YEARS OLD
• NO INTRODUCTION OR CONCLUSION NEEDED
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