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Nancy Jankowski began to initiate transformation change at Santorini Hospital by implementing a "self-learning model". How does this approach differ from the Scientific Management School of thought? Drawing from the lecture on teams and team effectiveness, how can Nancy Jankowski ensure that the implementation of the model will be successful? Support you answer with theory and examples from the case.

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THE NEW JOB It is January 5, 2007, Nancy Jankowski's first day on the job as Santorini Hospital's new chief executive officer (CEO). She arrives to a hospital full of turmoil. Her predecessor, Alex Roth, who had before been the hospi- tal's chief operating officer (COO), resigned a few months earlier under intense pressure from the medical staff and the community. The interim CEO, Agnes Williams, halted the hospital's expansion project and laid off over 100 nonclinical staff. Physicians, nurses, and support staff were up in arms. The hospital was in the local headlines almost every day. THE HOSPITAL TODAY In 1913, Rene Santorini, M.D., performed the first operation in his new hospital in Athens, California. In 1937, Dr. Santorini moved the hospital This case is based on actual events. The organization, its location, and the names of peo- ple have been disguised.

360 Human Resource Management Santorini Hospital 361 colleague, Dr. Celia, of taking sides with Santorini Hospital. Dr. Cris Other physicians also left the call schedule. Five months after AAG alleged that Dr. Celia was ordered by then-CEO Roth to spy on him by left, the orthopedic group left the hospital. That same month, a prominent driving by his house to check if there was a pro-union sign on his front vascular surgeon left the call schedule. The cardiac surgeon that Santorini yard. Dr. Celia, without hearing the tape, gave consent for it to be played. Hospital relied on for its cardiovascular center of excellence left the hos- The audiotape did not reveal any such order from Roth, and the stage had pital and took his entire cardiac surgery team with him. Trauma surgeons, been set to steer the discussions away from AAG to Roth exclusively. radiation oncologists, a hospitalist, a psychiatrist, an interventional cardi- Dr. Cris argued vigorously that Roth was the cause of all of the hospital's ologist, and two radiologists also left the hospital. With the exodus of problems. Most of the discussion in the meeting had to do with Roth being physicians and nurses, a local newspaper labeled Santorini Hospital a dan- dictatorial and vindictive. Some accused him of using "security" as the gerous place. reason for placing cameras in the hospital as a cover for spying on the staff. The physicians overwhelmingly gave Roth a vote of no confidence. A NEW SKIPPER AT THE HELM A SHAKEUP LOOMS Santorini Hospital's board of trustees selected Nancy Jankowski as the new CEO in January 2007. She brought 25 years of executive management The vote of no confidence was published in the local newspapers and became experience with her. Her tenure at her last hospital, Florence Adventist the topic of conversation in Athens. Roth did not comment on the vote and Hospital in Maryland, was a testament to her leadership abilities. Prior to concentrated on the loss of AAG. The Santorini Hospital started prioritizing Jankowski's reign there, Florence's administration also received a vote of its surgery schedule. It hired some anesthesiologists from nearby hospitals no confidence. Unlike Santorini, Florence Adventist Hospital was about to and employed locum tenens as well. This gave Dr. Celia time to recruit new lose its accreditation when Jankowski took over. She guided Florence from physicians to Roth's newly formed group, Valley Anesthesiology Partners. the brink of collapse to being an award-winning hospital. In addition, the While Roth tried to manage the anesthesiology crisis at Santorini fact that Jankowski was an RN brought her instant credibility with Hospital, he could not stop the momentum that the service employees had Santorini's nurses and physicians. Jankowski considers herself an "acciden started, culminating in the no-confidence vote by the physicians. After tal CEO." She readily admits that she did not have formal training to extensive coverage in the media, Roth announced his retirement, his last day become an executive, but she always had a passion for patient care. being the end of the month. The board of trustees announced an immedia Healthcare professionals at Santorini Hospital received the news of ate search for his replacement. With Roth's departure, half of the board Jankowski's selection with guarded optimism. Their agenda included let- members, including the chair and the vice chair, also announced their resig- ting the new CEO know of their concerns, such as lack of openness and nations. Santorini Hospital was experiencing a broad changing of the guard. transparency. SEIU wanted, at last, to bargain with the hospital's adminis- Interim CEO, Agnes Williams, was brought in while the hospital cration. The physicians wanted the hospital's leaders to repair their dam- recruited its next CEO. Williams was known for coming into troubled hos- aged relationship. Everyone wanted a change in the style of management. pitals. In her short stay at Santorini Hospital, she determined that the facil- When Jankowski arrived, she announced that her primary focus was to ity was in financial trouble, so she announced the layoff of 5% of its work- change the hospital culture. She set about this task immediately. force. This included the same secretaries and business office employees who had refused to join the SEIU. In addition, she questioned the value of the expansion project and halted actions leading to ground breaking. EARLY STEPS IN CHANGING THE CULTURE The issue of not having enough anesthesiologists was still in full swing. Recent patient deaths at Santorini Hospital were prominently covered in Even before her arrival, Jankowski ordered a focused review of the surgery the local newspapers. The sheriff's department got involved in the investi- and anesthesiology departments. She was establishing a proactive gations of three deaths, one of which had a clear connection to anesthesiol- approach to managing the hospital and sought to identify issues before ogy. The sheriff's department wanted to determine if the hospital's anesthe- they became problems. The first action Jankowski took after she arrived siology department posed a danger to the public. Several local physicians was to reinstate the laid-off service employees, who also received back pay alleged that Santorini Hospital was supporting the practice of dangerous for the period of their layoff. She recognized the SEIU union, 3 years after by hirin the service employees had voted for it. On May 22, 2007, bargaining talks

362 Human Resource Management Santorini Hospital 363 between SEIU and Santorini's administration commenced. Subsequent deficiencies found in the April survey had already been corrected and that weekly talks and the content of those meetings were published on the hos- no problems jeopardized patient care or safety. True to her commitment of pital Web site, a first for Santorini Hospital. transparency, Jankowski published the results of the follow-up survey On her first days at Santorini Hospital, Jankowski focused on culture In October 2007, the California Department of Public Health fined change through increased transparency. Communication with employees Santorini Hospital $50,000 for inadequately monitoring a drug that eases and the medical staff improved considerably following her arrival. nausea but has dangerous side effects. Jankowski knew that inspections Together with her management team, Jankowski began sending weekly became more frequent when negative publicity and adverse events oc- messages on a general voicemail about what was going on in the hospital. curred; however, she was confident that the organization would be better Employees and the medical staff could call this voicemail box anytime and prepared for the next survey. listen to her CEO report. Jankowski wanted to let the employees know that messages she left for them through her voicemails were not just her interpretations; they included feedback from all of the managers. She also JANKOWSKI BEGINS TO wanted to put a voice to her name because she recognized that most of the CHANGE SANTORINI'S CULTURE employees had never met her. She also invited the physicians to a get-to-know-you meeting during Jankowski remains committed to culture change at Santorini Hospital. In which she jokingly told them that they were only allowed one vote of no addition to being more transparent, she is encouraging accountability confidence in their lifetimes. Jankowski also began communicating signif- within the organization. She expects the staff to follow policies and proce- icant news about the hospital to the medical staff via fax. dures and holds her senior management team accountable for their per- formance. Her CEO report is the same report that is presented to the board of trustees as well as to the staff. She holds her management team THE REGULATORS: accountable for the contents of the report. A NEW COMPLICATION FOR JANKOWSKI Jankowski is transforming the management of Santorini into a "self- learning" model. She began by assessing the talent level of all senior man- Days before Jankowski's arrival, the State Department of Health Services agers. Those who could not lead by engaging the staff were let go. Thus, (DHS) sent a nurse to inspect Santorini Hospital in connection with the many of the senior managers have taken on added responsibilities until death in February of a 44-year-old patient, who had been in the hospital suitable middle managers are found. The self-learning model begins at the for elective shoulder surgery. The inspector reported her findings to the top, with senior managers adopting the new management style first. They Centers of Medicare and Medicaid Services, which subsequently asked then teach it to their middle managers, who will in turn teach it to the DHS to do a follow-up inspection. On April 3, 2007, the original DHS supervisors, until all employees and medical staff become accustomed to inspecting nurse as well as a physician carried out a more extensive 5-day self-managing. survey of the hospital. Jankowski knows that this management style will not work for all In the past, the staff had resisted such surveys. Jankowski emphasized departments at the hospital. She knows that there are different talent levels; to them that the surveyors were there to help the hospital identify and fix this style requires a more sophisticated manager. She also understands that problems. She also expressed that she wanted to change the culture of this type of leadership will thrive in certain departments, such as the emer- ignoring problems and fighting those who pointed out problems, as the gency department, but may not work well in others, such as food service. surveyors had been asked to do. After their inspection, the surveyors told Jankowski has lofty goals, but knows that the self-learning model might turn Jankowski that their experience was more positive than in the past. out to be a hybrid of self-management and regimented management. Jankowski immediately put into place corrective actions. This process, however, was for a time interrupted when Jankowski was injured in an accident during a family trip and could not return to work for a few weeks. GOING FORWARD During her absence, a team of 10 DHS inspectors arrived to conduct another top-down inspection of the hospital. The survey was unannounced Jankowski is strongly committed to changing the former culture of not and the surveyors found deficiencies in seven areas, although they were being accountable, finding blame, and not collaborating at Santorini mostly administrative in nature. The surveyors reported that many of the Hospital. She believes it starts with her. She publicly acknowledges she can

364 Human Resource Management do very little as a CEO; the job of culture change is really accomplished through other people, such as the staff, RNs, and physicians. Whenever she is in contact with the staff, she makes sure their experience is always positive. She is even taking the stalled expansion project further. Construction has begun. Jankowski is putting her touch on the entire project by redesigning it from the inside out. In the future, Santorini Hospital will be patient centered. All services will be designed around the patient. The aes- theties, such as the lighting and decor, will be pleasing. Nurses will struc- ture their work around the patients and their families. Jankowski's vision is to have a hospital that employees would want to bring their own families to. She wants a hospital so good that it will be the hospital of choice for the community. She is very optimistic, believing that the hospital is well positioned in the market. The problems she inherited are not insurmountable. The reg- ulators are more satisfied because the hospital is cooperating and correct tions are being made. Although physician call is still a major problem, there are signs of improvement. The new anesthesia group, Valley Anes- thesiology Partners, is almost at full strength. Only two more physicians need to be recruited to meet the hospital's minimum requirement of 14 full-time anesthesiologists. In general, more physicians are applying because of the hospital's turnaround. The bargaining process with the SEIU is still in progress. Jankowski knows she will need to appease the service employees quickly. Because the RNs filed a grievance and authorized their leaders to call a strike only days before Jankowski's arrival, she knows that she will need to bargain with the RNs as well. The emergency room physician call schedule is still not fully covered. There is also the $140 million expansion project that is supposed to be completed within 3 years. As part of her plan, Jankowski has reached out to nearby hospitals. She is in discussions with their CEOs to share ideas and resources and not to take each other's business. She wants her hospital to work with the oth- ers in serving the community. Jankowski remains positive in continuing the turnaround. She has to. She made a commitment to Santorini Hospital that this is her last stop. She plans to retire from the hospital when the time comes. Jankowski pub- licly attests that Athens is a great community that deserves a great hospi- tal. And with her leadership, she believes Santorini Hospital can become the big-time hospital with the small-town feel. Jankowski thinks Santorini Hospital is well under way to achieving her hopes for it to be a great hospital, but she wonders what else she can do to ensure this outcome.

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