MHA-FP5040: Health Administration Change Leadership

MHA-FP5040: Health Administration Change Leadership

MHA-FP5040: Health Administration Change Leadership

Assessment 2- Case Study Analysis- Part 1

Complete Part 1 of an in-depth analysis of the case study “Case Study 5: Ellen Zane—Leading change at Tufts/NEMC.” Your 6–8-page analysis will focus on the problems facing Tufts/NEMC and the approach(es) the organization used to position itself for the necessary changes.

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Note: The assessments in this course build upon the work you have completed in the previous assessments. Therefore, complete the assessments in the order in which they are presented.

A clear understanding of the need for change and the nature and extent of the change is necessary to communicating and heightening awareness within the organization and gaining the support of all internal and external stakeholders. Health care leaders must demonstrate that change is necessary to ensure the future success of the organization and its mission, and must begin the change management process with an analysis of complex, dynamic processes and organizational components.

This assessment provides an opportunity for you to examine the internal and external factors driving change in an organization, how the organization responds to the need for change, and how it heightens awareness of that need. MHA-FP5040: Health Administration Change Leadership

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 1: Analytical Thinking: Develop complex plans or analyses.
    • Analyze the multiple elements of a problem.
  • Competency 2: Change Leadership: Challenge the status quo.
    • Analyze approaches used to heighten awareness of the need for change in an organization.
    • Explain how effectively an organization challenges the status quo with respect to an ideal or to a vision of change.
    • Assess an organization’s efforts at creating a realistic sense of crisis or a disequilibrium to prepare for change.
  • Competency 5: Performance Measurement: Use evidence-based approaches to support community wellness.
    • Assess the needs of a community as they relate to a health care organization.
  • Competency 6: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards.
    • Write clearly and concisely, using correct grammar and mechanics.
    • Support main points, claims, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.

Templates

Use this template for your case study analysis.

Required Resources

The following resource is required to complete the assessment.

Resources

 

Suggested Resources

The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MHA-FP5040 Health Administration Change Leadership Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.

Organizational Change

The following resources may be of use to you in your analysis of the problems facing Tufts/NEMC and the approach(es) the organization used to position itself for the necessary changes.

Writing Resources

You are encouraged to explore the following writing resources. You can use them to improve your writing skills and as source materials for seeking answers to specific questions.

Additional Resources for Further Exploration

  • Cawsey, T. F., Deszca, G., & Ingols, C. (2016). Organizational change: An action-oriented toolkit (3rd ed.). Thousand Oaks, CA: Sage. Available from the bookstore.
    • Chapter 3, “Frameworks for Diagnosing Organizations: What to Change in an Organization,” pages 64–93.
    • Chapter 4, “Building and Energizing the Need for Change,” pages 94–140.

Assessment Instructions

Note: This assessment must be completed prior to Assessments 3 and 4. Therefore, complete the assessments in this course in the order in which they are presented.

Preparation

Read the case study, “Case Study 5: Ellen Zane—Leading change at Tufts/NEMC,” linked in the resources.

Note: Remember that you can submit all—or a portion of—your draft analysis to Smarthinking for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.

Requirements

Analyze the problems facing Tufts/NEMC and the approach(es) the organization used to position itself for the necessary changes.

Document Format and Length

Format your analysis using APA style.

  • Use the APA Style Paper Template, linked in the Required Resources. An APA Style Paper Tutorial is also provided (linked in the Suggested Resources) to help you in writing and formatting your analysis. Be sure to include:
  • Your analysis should be 6–8 pages in length, not including the title page and references page.

Supporting Evidence

Cite 3–5 sources of credible, scholarly evidence to support your analysis.

Case Study Analysis

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. Be sure that your analysis addresses each point, at a minimum. You may also want to read the Case Study Analysis—Part 1 Scoring Guide to better understand how each criterion will be assessed. Be sure to note the requirements in the Distinguished column. MHA-FP5040: Health Administration Change Leadership

  • Analyze the multiple elements of the problem.
    • Break down the problem into its fundamental components, showing causal relationships.
    • Separate the layers of the problem (for example, contracting issues, insufficient cash on hand, high accounts receivable, et cetera) into smaller, manageable components.
    • Consider the effects of each aspect of the problem on the organization.
  • Assess the needs of the community as they relate to the organization.
    • How do those needs affect the organization?
    • How can the organization respond to those needs to improve outcomes within the community?
  • Analyze five approaches used to heighten awareness of the need for change in an organization.
    • Apply your understanding of these approaches to the case study.
    • Compare the effectiveness of these approaches in heightening awareness.
  • Explain how effectively the organization challenged the status quo with respect to an ideal or to a vision of change.
    • How would you describe the status quo and the ideal state or vision of change?
    • What did these challenges hope to achieve? Were they successful?
    • What evidence supports your conclusions?
  • Assess the organization’s efforts at creating a realistic sense of crisis or a disequilibrium to prepare for change.
    • How did the organization energize and motivate people to agree to the change?
    • Were the organization’s efforts successful? Why, or why not?
    • What evidence supports your conclusions?
  • Write clearly and concisely, using correct grammar and mechanics.
    • Express your main points and conclusions coherently.
    • Proofread your writing to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your evaluation.
  • Support main points, claims, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.
    • How or why does particular evidence support your main points, claims, or conclusions?
    • Is your supporting evidence clear and explicit?
    • Will your audience see the connection?

 

attachment_4Full Title of Your Paper

Learner’s Full Name (no credentials)

Capella University

Course Title

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Month, Year

Abstract

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Keywords: [Add keywords here.]

Title of Paper

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References

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attachment_5CHALLENGES AT TUFTS/NEMC

1990’s
Medicare and Medicaid reimbursement less than cost.

1991-1996
24% decline in hospital discharges and average length of stay.

1990’s
Massachusetts insurance plans merged creating increasing power in the marketplace.

1991
Hospital deregulation.

1990’s
47 acquisitions and mergers, 19 acute care hospital closures, and 10 new major hospital systems.

Thru 2005
Lack of capacity due to years of merging and downsizing.

Thru 2005
Pay for performance gaining in popularity.

Thru 2005
Difficulty recruiting new doctors and nurses.

Thru 2005
Increasing bad debt due to uninsured and underinsured patient population increase.

CREDITS

Subject Matter Expert:

Darleen Barnard

Interactive Design:

Tara Schiller

Instructional Designer:

Marisa Johnson

Project Manager:

Catherine Baumgartner

 

TIMELINE OF EVENTS AT TUFTS/NEMC

INTRODUCTION

Tufts/New England Medical Center (NEMC) is an Academic Medical Center (AMC) located in Boston, Massachusetts that has undergone major change since its inception in 1796. The following timeline supports the case study in your text and highlights the major milestone experiences at Tufts/NEMC. As you review the timeline, reflect on the course materials and think about how you would handle the situation at each milestone. What could have been done differently?

1796: Boston Dispensary was Formed

The Boston Dispensary was formed by Samuel Adams and Paul Revere. It was the first permanent medical facility in New England and quickly gained a reputation for innovation. MHA-FP5040: Health Administration Change Leadership

1929: New England Medical Center (NEMC) was Formed

NEMC was formed by the merger of the Dispensary and Tufts College Medical and Dental Schools. By 1965, Floating Hospital and the Pratt Diagnostic Clinic-New England Center Hospital were both added.

1990: $130 Million in Debt

Tufts/NEMC was $130 million in debt.

1992: Boston’s First Private Teaching Hospital

Tufts/NEMC became the first full-service, private teaching hospital in Boston. Thanks to extensive innovation including strong cancer treatment programs, transplants, and a neurosurgery program, Tufts-NEMC became the first full-service, private teaching hospital in Boston and added a maternity service.

1995: Harvard Pilgram Health Care discontinued coverage to Tufts/NEMC

In a particularly devastating blow to the hospital, Harvard Pilgram Health Care removed Tufts/NEMC from their network. Physicians began sending patients to Brigham which further threatened the financial viability of Tufts/NEMC.

mid-1990s: Tufts/NEMC Begins to Look for A Partner

Because Tufts/NEMC needed more clout with the health plans, more referrals from community hospitals, and a partner to help pay for growth, Tufts/NEMC began talks with Columbia/HCA – a for-profit hospital chain from Tennessee that wanted to expand in New England. Talks later occurred between Tufts/NEMC and Lifespan Corporation- a regional non-profit hospital system that appeared to be a better fit at first glance.

1996: $240 Million in Debt

Tufts/NEMC was losing physicians, market share, and hospital acquisitions to Partners and CareGroup. Tufts/NEMC had been slow to react to market pressures and was ineffective in improving processes and cash flow.

1997: Neely House Opened

The Neely House was a bed and breakfast inside hospital for cancer patients and their families.

1997: Tufts/NEMC & Lifespan Merge

“The merger created a $1.5 billion, 14,500-employee health care giant with the ability to serve 70 percent of the entire New England market”. Problems quickly emerged and the gains for both organizations were never realized. Rhode Island regulators objected to large amounts of capital migrating to Boston and required Lifespan to reduce the amount Tufts/NEMC was to receive to $8.7 million for 10 years. This was another devastating blow from the 30 years originally planned.

2000: Lifespan/Tufts/NEMC Lost Hallmark Health System

The additional corporate layer that resulted from the merger between Tufts/NEMC and Lifespan was the primary reason that the deal did not happen.

2001: Transplant Exchange Program

Tufts/NEMC opened a transplant exchange program.

2001: Lifespan Suffers Operating Loss of $34.1 Million

Lifespan did not understand the cost of doing business in Boston and negotiated reimbursement rates below the average for an Academic Medical Center in Boston. As a result, Lifespan lost $34.1 million on total revenue of $1.3 billion.

2002: Lifespan and Tufts/NEMC Separate

Five years after they merged, Lifespan and Tufts/NEMC agree to separate at a cost of $30 million to Tufts/NEMC.

2002: Tufts/NEMC suffers $12.3 Million Loss

Tufts/NEMC suffers $12.3 million loss.

2003: Tufts/NEMC suffers $38.5 Million Loss

At this point the organization was beginning to make drastic changes. Ed Schottland returned as COO and started initiatives to stem reduce the million dollar losses. Schottland also targeted improvements of $30 million in cost savings in supply chain and human resources. Tufts/NEMC reduced staffing by 200 FTEs throug attrition and consolidation and made improvements to supplier contracts. The hospital began investigating the ability to see 1.5 million square feet of prime real estate to gain capital. The Board began looking for a new leader who could turn the organization around…Enter Ellen Zane…

CREDITS

Subject Matter Expert:

Darleen Barnard, DHA, MBA, CHFP

Interactive Design:

Alyssa Jensen

Interactive Development:

Peter Hentges

Instructional Design:

Marisa Johnson

Project Manager:

Catherine Baumgartner

Image Credits:

Artist Unknown. “[Boston Medical Dispensary, built 1883, corner Ash St. and Bennett St., Boston, Massachusetts]” Photograph. 1883. http://commons.wikimedia.org/wiki/File:1883_BostonDispensary_AshStreet_BennettStreet.png.

 

 

RATE THE ORGANIZATION’S READINESS FOR CHANGE

INSTRUCTIONS

For each statement that accurately reflects the state of the organization you are assessing, record the corresponding score. Total your score and reference the explanation at the end of this activity.

Previous Change Experience

Has the organization had positive experience with change? (Score +1)

Has the organization had failure experience with change? (Score -1)

What is the mood of the organization: upbeat and positive? (Score -1)

What is the mood of the organization: negative and cynical? (Score -2)

Does the organization appear to be resting on its laurels? (Score -1)

Executive Support

Are senior managers directly involved in sponsoring the change? (Score +2)

Is there a clear picture of the future? (Score +1)

Is executive success dependent on the change occurring? (Score +1)

Has management ever demonstrated a lack of support? (Score -1)

Credible Leadership and Change Champions

Are senior leaders in the organization trusted? (Score +1)

Are senior leaders able to credibly show others how to achieve their collective goals? (Score +1)

Is the organization able to attract and retain capable change champions? (Score +1)

Are middle managers able to effectively link senior managers with the rest of the organization? (Score +1)

Are senior leaders likely to view the proposed change as generally appropriate for the organization? (Score +2)

Will the proposed change be viewed as needed by the senior leaders? (Score +2)

Openness to Change

Does the organization have scanning mechanisms to monitor the environment? (Score +1)

Is there a culture of scanning and paying attention to those scans? (Score +1)

Does the organization have the ability to focus on root causes and recognize interdependencies on both inside and outside the organization’s boundaries? (Score +1)

Does “turf” protection exist in the organization? (Score -1)

Are the senior managers hidebound or locked into the use of past strategies, approaches, and solutions? (Score -1)

Are employees able to constructively voice their concerns or support? (Score +1)

Is conflict dealt with openly, with a focus on resolution? (Score +1)

Is conflict suppressed and smoothed over? (Score -1)

Does the organization have a culture that is innovative and encourages innovative activities? (Score +1)

Does the organization have communications’ channels that work effectively in all directions? (Score +1)

Will the proposed change be viewed as generally appropriate for the organization by those not in senior leadership roles? (Score +2)

Will the proposed change be viewed as needed by those not in senior leadership roles? (Score +2)

Rewards for Change

Does the reward system pay for innovation and change? (Score +1)

Does the reward system focus exclusively on short-term results? (Score -1)

Are people censured for attempting change and failing? (Score -1)

Measures for Change and Accountability

Are there good measures available for assessing the need for change and tracking progress? (Score +1)

Does the organization attend to the data that it collects? (Score +1)

Does the organization measure and evaluate customer satisfaction? (Score +1)

Is the organization able to carefully steward resources and successfully meet predetermined deadlines? (Score +1)

Scoring

Scores can range from -10 – +30. If the organization scores below 10, it is not likely read for change and change will be very difficult. The higher the score, the more ready the organization is for change. Use the scores to focus your attention on areas that need strengthening in order to improve readiness. Change is never “simple,” but when organizational factors supportive of change are in place, the task of the change agent is manageable. MHA-FP5040: Health Administration Change Leadership

REFERENCES

  • Cawsey, T. & Deszca, G. (2007). Toolkit for Organizational Change. Thousand Oaks, CA: Sage Publications, Inc. Page 103.

CREDITS

Subject Matter Experts:

Darlene Barnard

Interactive Designers:

Alyssa Jensen

Interactive Developers:

Peter Hentges, Justin Lee

Instructional Design:

Marisa Johnson

Project Manager:

Catherine Baumgartner