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Example research essay topic: Paradigm Shift Organizational Effectiveness - 1,726 words

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Research & Writing First Draft Implementing continuous quality improvement in acute care general hospitals can be viewed as an occurrence of a paradigm shift and organizational learning. And that is what we should do to be in compliance with the Federal requirements set forth in the Medicare Conditions of Participation (CoP) in order to receive Medicare/Medicaid payment. The conflicting stakeholder goals of quality of care and cost savings are to be harmonized. Organizational members should undergo both a cognitive and behavioral adjustment centered on teamwork, facilitated by training and education.

Teamwork and involvement of physicians currently remain long-term challenges for achieving fully compliance of our Utilization Management Plan. In the 1990 s, the quality revolution continued to spread from the private to the public sector in the United States (Lewis, 2000, p. 128). Total quality management, and its progeny, continuous quality improvement (QI), were formalized programs mobilizing entire organizations. Public sector organizations, such as hospitals, were encouraged by government and regulatory agencies to adopt QI to deliver quality medical services with fewer resources. With long-term funding constraints on the rise in public hospitals and with increasing patient demands, QI was considered a promising paradigm that would allow hospitals to meet these goals. Continuous quality improvement (QI) goes beyond traditional quality assurance and standards (Mahmoud & Rice, 1998, p. 8), and cuts across the exclusive domains of control of the professional, physician and administrative groups.

Moreover it directed to assist patients who are not getting the proper treatment and physicians who are inconsistent with evidenced-based medicine we are going to implement and support in our hospital. QI aims for continuous improvement through inclusive teamwork and involvement of frontline workers, systematic analysis of problems and data collection, and subsequent modification of hospital structures and processes (Hackman, J. R. , & Wageman 1995, p. 305). Among the measures of hospital utilization are number of admissions, average daily census, average length of stay, total patient days, monitoring of Case mix Index, Variance/Avoidable Patient Days, Payment Flow Management, Denial management and completion of Medical records. Thus, QI represents a major organizational change that attempts to transform a hospital into a more adaptive and effective organization. QI has been implemented in many sectors of the economy, including health care, with mixed results (Lebrasseur, Whissell, & Ojha, 2002, p. 141).

As in other major organizational changes, success in implementing QI requires effective executive leadership (Temple, Tyler, Nelson, Winstanley, & Chicota, 2004, p. 175). The medical establishment has characterized QI as a paradigm shift. A paradigm consists of a constructed 'reality' that is shared by organizational members. This reality is composed of shared values, beliefs, and attitudes that form a coherent whole, and provide the rules, standards, and examples of appropriate practice and conduct in the workplace (Hackman, J. R. , & Wageman 1995, p. 306).

The concept of paradigm represents the cognitive dimension of culture and forms a 'blueprint' for human interactions. The paradigm shift of CQI in the healthcare sector introduces a shift in many beliefs and attitudes (Berwick 1989 cited in Lewis, 2000, p. 129): From Meeting standards Quality costs more Improvement within dept. Management by authority Management as controller Employees as problems To Continuous improvement Quality focuses resources Improvement across departments Management by fact Management as collaborator Employees as problem-solvers These changes should lead to modifications of behaviors and routines that, if adopted, might transform the traditional hospital into a high-performing organization. However, existing organizational paradigm is resistant to change, and therefore any attempt to shift the traditional paradigm to QI requires careful introduction. The concept of paradigm shift describes an organization-wide change. Organizational learning brings about these changes.

This learning involves the revision of the cultural foundation of the organization (its assumptions and values) in order to create a new problem-solving approach. Members of an organization consciously modify the cultural context to build new expectations and actions (Mahmoud & Rice, 1998, p. 9). Thus, in the process of following the plan by our case managers and physicians to meet both Medicare CoP and Joint Commission (JCAHO) we " re going to evaluate the plan by collecting data that measures the performance of the utilization management plan, our adherence to the plan, use the information from data analysis to identify and implement changes that will improve the quality of care, treatment and services. For such an analysis we " ll compare our results with data obtained from Case Management Society of America (CMSA) and their state Quality Improvement Organization (QIO). This data will also be used for the Hospital Quality Alliance (core measure data) required for Medicare public reporting available on Hospital Compare and become part of the physician quality profiles that will be used for reappointment. Any findings and / or changes made to improve processes or outcomes of utilization review / case management will be evaluated to ensure that they achieve the expected results.

Appropriate actions will be undertaken when planned improvements are not achieved or sustained. According to Mang (1995, p. 427), not all organizations are prepared or sufficiently viable to undertake the social reconstruction that is at the core of organizational learning. Therefore, some organizations initiating QI may experience limited success. Progress often remains uncertain as contextual factors (culture, structure, environment) influence or even delay the change process (Fleming & Steen, 2003, p. 17). Since successful QI implementation may require a sustained effort over several years, organizational members will depend on the leadership of the CEO and senior management to understand and interpret the relevant environmental pressures, and to situate QI within the overall hospital strategy (Lyons & Callahan, 1996, p. 133. As the organization makes internal adjustments, it does so with the goal of ensuring overall organizational effectiveness (Lewis, 2000, p. 130).

Eventually, organizational learning should noticeably improve the performance of the hospital. Among the adjustments we currently need is a lack of key personnel knowledge of regulatory standards. To investigate QI implementation as an example of organizational learning, we may adopt the framework for managing change as proposed by Pettigrew (1987 cited in Fleming & Steen 2003, p. 29). Specifically, the dynamics of change can be understood by examining the content (e.

g. QI Council, tools for data collection and analysis) of change in relation to the process (e. g. CEO leadership, agendas, actions and reactions) of this change. This examination is situated within the inner context (e.

g. strategy, culture and structure) and outer context (e. g. pressures from outside agencies) in which the change is taking place. QI implementation is a change process where organizational goals are implemented, evaluated and modified through purposeful social construction among organizational members (Lyons, & Callahan 1996, p. 138). Organizational effectiveness may be also viewed as the harmonization, pursuit and attainment of the goals sought by the various stakeholders of the organization (Mang, 1995, p. 433).

With diverse stakeholders, it becomes difficult to satisfy all parties equally. Specifically, QI seeks to achieve both the medical goal of quality care and the managerial goal of efficient operations. In such a way compliance with CoP, JCAHO implies educational training for all case management staff with national criteria and adherence to utilization management plan thus, reducing risks of over-utilization of our hospital services. During the initial stages of QI implementation in a hospital, the following components are recommended: a) coordinating mechanisms including a quality council and a quality coordinator; b) an education & training program; c) a communication program; and d) pilot projects (Mahmoud & Rice, 1998, p. 10). Assuming that senior management commitment is high and the resources allocated are plentiful, the quality council builds the necessary sub-committees to plan, develop, and deliver a coherent program. Pilot projects lower the departmental barriers that separate the medical disciplines and administrative areas.

These projects offer a non-threatening opportunity to translate the CQI initiatives directly into actions or into repertoires for future action. Under the guidance of a quality council, the above components may have a synergistic impact on all concerned (e. g. a clear message accompanied by a practical demonstration). A QI program achieves coherency when it is understood by staff, reinforces new concepts and expectations, and links these concepts to new practices. Accordingly, a coherent program avoids creating unnecessary resistance and reinforces individual learning experiences.

Furthermore, the development of pilot projects and temporary teams helps to establish a community of practice, that is, loosely connected individuals and groups sharing common interests and goals (Lewis, 2000, p. 131). Though voluntary in nature, we should remember that this accreditation is considered a seal of excellence and is actively sought by major U. S. hospitals. These developments have been accompanied by a steady promotion of QI training and education events by national healthcare bodies and by healthcare management associations. Fleming. & Steen (2003, p. 114) define strategy as the actions and steps taken to satisfy stakeholders under changing external and internal organizational conditions.

Within the health care context, acute care hospitals traditionally adopted a best provider strategy by offering a variety of specialized medical interventions and treatments to the general population (Mang, 1995, p. 429). With strong external pressure from funding agencies, these hospitals have shifted to a best-cost provider strategy as they strive to provide more health care value for the public funds supplied. Senior management simultaneously manages costs down and augments service caliber. Thus, QI may be viewed as an integral component of the new best-cost strategy. Moreover our plan is designed to protect the Medicare beneficiaries' rights, improve quality of care, and protect the integrity of the Medicare Trust Fund. Severity of Illness and Intensity of Service (SI/IS) inpatient criteria and invasive procedure criteria should be used for screening cases for utilization issues to ensure the patient receives the appropriate care within the appropriate setting (i.

e. , ICU, Long Term Care, Acute Medical, etc. ). The full adoption of QI requires the concerted efforts of individuals operating through new structures and systems that encourage teamwork (Lyons & Callahan, 1996, p. 137). Initially, the CQI council, committees, and projects are superimposed on the existing hospital structure, which may be initially unreceptive to QI. Traditionally, hospitals were classifiable as complex bureaucratic organizations with clear internal boundaries and stratification (Lebrasseur, Whissell, & Ojha, 2002, p. 145). There was very little scope for communication between functions or across levels of hierarchy.

Even when professionals worked together in a team, each performed a specific...


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