The case describes a situation that happened to a new director of ambulatory care, Dr. Grant, preoccupied with an overcrowded emergency department. Families and patients are waiting for hours due to a limited number of beds and a staff shortage. For this reason, the hospital would regularly send incoming ambulances to other medical centers. Despite the nurses’ reassurances that this is a typical order of things, Dr. Gant advocated solving the problem with a strategy that had been successful in his previous job. However, the new director’s ideas fail to find proactive support and commitment within personnel and administration. As a result, passive attitude and adverse organizational climate hinder effective plan implementation leading to collective discontent and accusations against Dr. Gant.
The problem can be broken down into several levels. Individually, staff members turned out to be not that much concerned with an issue and therefore did not demonstrate engagement. Moreover, personnel is required to be able to cope with the electronic registration system. To address the individual level of the problem, the SMART approach would be as following:
- Specific: communicate the criticalness and the root cause of the situation to the staff members, as well as the strategy aimed to improve it. Besides, each employee should be trained in terms of technology use.
- Measurable: personnel must demonstrate their commitment as well as the gained competencies and awareness through testing.
- Achievable: looking back to other implementations of system changes and employees’ qualifications and skills, the deadline for this stage must be established accordingly.
- Relevant: the number of staff members, documentation, arrangement of equipment, technology features must be adequately estimated and correspond to the planned changes.
- Time-bound: personnel must be aware of the deadline of the stage. Absent employees must also have separate training and testing deadlines.
On the team level, the problem arose from the lack of effective human resource management. The unregulated workflow slowed down the already insufficient personnel and hampered access to a clinician. Subsequently, the neglect of appropriate staff organization led to the failure of Dr.Gant’s strategy. To fix the problem, the SMART solution is suggested to be as following:
- Specific: based on the trends, adjust the staffing matrix to speed up the workflow considering holiday and sick days. Moreover, a favorable organizational climate must be achieved.
- Measurable: the time to serve a certain number of patients should be measured before implementing the planned strategy. Given the scale of the change and available experience, new timelines should be mapped out and linked to employee incentives.
- Achievable: it is necessary to consider the characteristics of the premises and the layout to ensure the adequacy of the planned innovations.
- Relevant: the implementation strategy should address root causes and problems and close gaps in the patient flow.
- Time-bound: the time to implement changes should be calculated based on the criticality of the situation and the availability of personnel.
Finally, the system-based problem lies in adequately estimating the number of beds and staff availability on each work shift. The root of the problem may likely be, among other things, due to the planning of available resources, including equipment, room configuration, and so on. Moreover, it is necessary to establish an inclusive organizational structure where each team member can share their opinions and suggestions for improving performance (Schneider et al., 2013). The SMART objective can be drafted as follows:
- Specific: introduce a feedback system and take into account the availability of all the necessary resources to implement the changes.
- Measurable: feedback culture can be measured by the number of ideas coming in from employees. The result of resource planning should be a quantitative display of the missing elements
- Achievable: when calculating resources, it is essential to take into account the availability of a budget for changes and assign responsibility for the feedback.
- Relevant: an engaging organizational culture should make work easier, not hinder it. Resource accounting should solve the problem and simplify the work of staff.
- Time-bound: establishing an organizational culture can take time and should be gradual. Time should be calculated for the long term. Accounting for the resources required to implement systemic changes should have a shorter time frame and precede the implementation of the strategy.
Following all of the above, Dr. Gant could have avoided this situation if he had built his strategy according to the SMART approach. It was necessary to take into account the different levels of the problem. Besides, when drafting the plan, the new director should have found the root causes of the circumstances, determined a benchmark measure, and set an adequate time frame based on available resources. Dr. Gant also disregarded organizational culture and climate and did not consider the motivation of employees, their attitude to the problem, and feedback. All these factors did not work in favor of the director and led to failure.
In conclusion, recommendations are offered for further resolution of the problem. First of all, the doctor needs to establish his leadership role in the team and earn respect. Schein (2016) advises not to start this journey by collecting feedback, but on the contrary, demonstrate involvement by own example and analyze the situation. It may be that staff are not motivated to carry out assignments effectively. Hence the organizational culture is not conducive to change (Schneider et al., 2013). In this case, it is worth starting with climate change in the team. In addition, the doctor should plan the next steps based on the analysis of the organizational environment and the availability of the necessary resources for change. This approach will help to avoid fatal mistakes in management and improve relationships in the team.
Schein, E. H., & Schein, P. A. (2016). Defining the Structure of Culture. In Organizational Culture and Leadership (5th ed., pp. 1–76). John Wiley & Sons.
Schneider, B., Ehrhart, M. G., & Macey, W. H. (2013). Organizational Climate and Culture. Annual Review of Psychology, 64(1), 361–388.