workplace re engineering change factors

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Workplace Reengineering, Reorganization, and Redesign: The Driving Force forWorkplace Reengineering, Reorganization, and Redesign

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Introduction The Driving Force for Workplace Reengineering, Reorganization, and Redesign Change in the Organization Leading Change Averting Conflict Related to Change Strategic Planning, Visioning, and Reengineering Reengineering Measures Implementing Organizational Redesign Employee Readiness and Support Strategies for Success

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Explore a hypothetical case in insomnia The Driving Force for Workplace Reengineering, Reorganization, and Redesign

No business can be stagnant and expect to survive. An ongoing transformation process is the norm, and when businessdoes not evolve with the environment, failure results. Hospital business activity is influenced by a variety of internal andexternal forces. Factors may include changes in reimbursement, a shortage or excess of labor, changes in the politicallandscape, the economy, and others. Managers must be cognizant of the environment in which they function in order toanticipate andrecognize the need for change and for facilities to remain viable entities.

External Forces

Organizations are currently analyzing trends in the healthcare environment as external factors come to bear on facilities.The current hospital environment can expect a flat-to-obvious decline in inpatient volumes over the next 5-10 yearsbecause of less invasive technologies and surgeries anda smoothing of demand, too, as more seniors maintain a healthylifestyle, including prevention and screening measures leading to early detection and lower acuity interventions. Thetransition from inpatient- to outpatient-driven strategies will keepthe higher acuity patient in the inpatient setting with aneed for more intensive care beds and fewer traditional inpatient accommodations. Consumer cautiousness related tocost of insurance, co-pays, and pharmaceuticals leads to fewer voluntary admissions in both inpatient and outpatientareas (Advisory Board, 2003).

The outpatient areas can expect a surge in volume as inpatient admissions are averted, but the reimbursement to the

facility is significantly lowered. Emerging technologies have the potential to drive more change as technologies such aspositron emission testing can avert surgical interventions by indicating malignancy in advance of or in place of biopsyprior to surgery. A continued rise in physician- or company-owned specialty hospitals and outpatient centers will siphonpatients from the traditional hospital setting, leading to a decline in both census and revenues as patients in the hospitalfacility generally become more acute and provide lower margins. Mergers, acquisitions, and closures of facilities alsoimpact both inpatient and outpatient volumes as patient duplications or absence of services result (Advisory Board,2003).

Changes in reimbursement are external factors with significant implications for volume shifts in the traditional hospitalfacility. With their higher overhead costs, hospitals often lose managed care contracts to outpatient imaging centers or physician offices or to other better-managed organizations willing to provide care at a lower price. Managed careorganizations (MCOs) are influenced by the purchasers of their product to deliver a lower cost of care. Business, theunderwriter of health care for much of the population, demands that the MCO negotiate lower rates to keep down thebusiness premium cost. Business also is offering to its employees graduated payment plans based on services selected.Many employees are selecting lower premiums leading to higher co-pays, which may be more difficult for the hospital tocollect. Coupled with changes in managed care costs are the dramatic fluctuations in government-sponsored
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reimbursement, such as Medicare and Medicaid. Annually, the centers for Medicare and Medicaid attempt to drive downthe reimbursement to both hospital and nonhospital settings. Of recent note has been the move to restructure physicianoffice reimbursement (lowering reimbursement) that may lead to an influx of chemotherapy patients from the physicianoffice outpatient setting back into the hospital outpatient setting. This type of movement would require a significantchange in the hospital, as most do not have sufficient infusion center capacity to handle this influx.

Being sensitive to the external forces that may influence a facility is important, but these same forces may translate tointernal impacts, which are equally important. For example, there are influencing factors that are difficult to segment into

external or internal forces on a consistent basis. Cultural impacts external to the facility can come from a shift indemographics in the market. A large foreign or indigent population shift may cause internal forces that necessitate theneed for translators or accommodations to the cultural needs of this population. Societal needs in the community mayinfluence hospitals both externally and internally. A hospital losing money on obstetrics may not be able to close theservice if they are the only provider in the community. Although the internal need is to close the service in order to savedollars, the external need is greater to keep the service. External forces may lead to internal influences or may standalone as a rationale for change. Once external forces are considered, the nurse manager should consider internal forces.

Internal Forces

Probably the most influential internal force impacting facilities is lowered margins, as reimbursement has steadilydeclined over past years. Arguably, lowered reimbursement is external to the facility in most instances, but the use of dollars can be determined as an internal factor that must be managed. As wages increased because of staff shortagesand technology costs increased with price increases from vendors, profits in the hospital were consumed. The use of dollars in service delivery decisions (e.g., cardiology versus oncology) has significant internal ramifications. Coupled withweakened infrastructure in the facility and sociopolitical factors within the management structure of the organization,these declining fortunes of the hospital industry beg for redesign. Drucker (1993) described the incongruous economicrealities of industry that translate well to health care. In most industries, when volume grows, profitability also grows. It ishard to understand why rising demand does not always equate to enhanced performance of the healthcare entity.Looking from the most obvious financial impacts, whether internal or external, to less obvious influences supports theneed of the organization for change.

The culture and history of the organization can influence responses to factors interpreted as threatening within the facility.

The internal climate that exists within a facility can determine the ability of the staff to accept change in a positivemanner. Poor morale, lack of trust, and a feeling of disengagement with the organization are internal factors thatinfluence the organization's ability to reform and succeed. If staff reductions are the immediate response to internalthreats without a clear plan of action, staff may not trust the organization to appropriately handle future events.Downsizing, whether through eliminated positions, department outsourcing, or layoffs, is an unfortunate trend in healthcare and often leads to more detrimental effects than it prevents. A secretive senior management also may lead todistrust on the part of employees as opposed to an open communication model in which staff are kept apprised of eventsthat may impact their future.

A thorough and ongoing assessment of external and internal factors exerting an influence on the organization is expectedof senior leadership to define a proactive plan of action in anticipation of strategic threats. By developing and

implementing a plan of action in advance of anticipated negative events, corrective measures may be initiated. Whether itis the development of a strategic plan or a process improvement study, forward-thinking organizations are defining anaction plan to respond to their environment in a positive manner, which is designed to accomplish their goals. Strategicplanning follows a well-known process of setting goals and defining implementation plans based on previous activities, anext step, so to speak. In contrast, reengineering is radical redesign implying a major upheaval within the facility. Bycarefully defining a strategic approach to workplace reengineering, reorganization, and redesign and incorporating theinfluences of external and internal factors, the process may be better managed, leading to a more positive outcome onthe facility and employees.

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Introduction The Driving Force for Workplace

Reengineering, Reorganization, and
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Redesign Change in the Organization

Leading Change Averting Conflict Related to Change

Strategic Planning, Visioning, andReengineering

Reengineering Measures Implementing Organizational Redesign

Employee Readiness and Support

Strategies for Success

Hospital A Hospital B Hospital C Hospital D Hospital E

FTEs 765 800 550 850 245

Lic beds 201 250 200 150 219

Beds srv 188 210 185 150 171

Pop 117,000 260,000 250,000 108,000 275,400

Est. cases 515 1,144 1,100 475 1,211

# cases 145 226 150 117 114Tot chgs 1,856,597 3,403,766 3,027,752 2,259,375 2,032,809

Chg/case 12,804 15,061 20,185 19,311 17,832

Net rev 924,959 1,447,781 917,336 894,691 779,298

Net rev/case 6,379 6,406 6,116 7,647 6,836

Tot LOS 662 1,007 636 640 584

LOS/case 4.6 4.5 4.2 5.0 5.0

What forces are driving change in the industry?The forces that are driving change in the industry are, the entry of Boston Market and Chick-fil-A's and other companies with different types of chicken. Boston Market was a new

restaurant chain that emphasized roasted rather than fried chicken. Boston Market created the image of an upscaledeli offering a healthy, "home-style" alternative to fried chicken and other fast foods. To make their different fromother competitive, Boston Market refused construct drive-through and established most of its units outside of shopping malls rather than major city intersection that would attract large numbers of customer, Also the differenttaste of chicken appealed to customer who preferred non-fried. Later Boston Market filled bankruptcy andMcDonalds acquired Boston Market. Which opened the industry to Popeye's Chicken as a major competitor toKFC. Popeye's Chicken shifting the focus to Cajun fast food, launching a Louisiana Legends One-Pot Cajun Mealof jambalaya, gumbo, shrimp, and crawfish etoufee. Also Church's also enter

Managing Change

In today's' economy, change is all-pervasive in organizations. It happens continuously and often at an alarming and rapidspeed. Because change has become such an everyday part of organizational dynamics, it is becoming increasinglyimportant to manage as any resistance to change by an organizations employees can actually cripple the organization.Resistance is, though, an inevitable response to any major change. People will by their nature rush to defend the status qif they feel their security or status is threatened (Kotter J.P. 1996). If management does not understand, accept and makeeffort to work with resistance, it can undermine even the most well intentioned and well conceived change effort (Coetsee1999). Any attempt by management to change without creating and maintaining a climate that minimizes resistance andencourages acceptance and support will be rendered fruitless. The purpose of this paper is to assist in minimizing or alleviating the prevalence of resistance that is being experienced at DCDM due to the structural and cultural changes thatare currently taking place. The change process is centered on a significant de-layering and decentralization of the
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external , grainger oss , internal external forces , behaviors organization , jackson hewitt's , maxx stores inc , bank york mutual , tj maxx stores , external forces economy ,

Are problems made to be solved? In my two Internet articles there were problems that both companies were tryingto solve. The first article was on Cisco System Inc. and the second article was on Chrysler. The articles describedhow each company went through a planned organizational change. "An organizational change is usually provokedby some major outside driving forces" (Carter, M.). The results could also change the organizational culture of acompany. Some of the outside driving forces could be from the need to increase in the area of productivity,

addressing a new market or cuts in funding. This was the exact case in both of the articles. The analysis will showhow each company handled their organizational change and their results. The first article is called Cisco'sComeback. This article describes how Cisco was considered the networking giant until their financial numbersstarted falling. Cisco hit a major slump and its CEO John T. Chambers had to do something about it. John T.Chambers and his top executives planned an o

By cleaning house and refocusing his workers on efficiency, cost cutting, and teamwork, Cisco came out of itsslump. They can look at the organizational culture to see if it is sufficient for the kind of organization that theyare running. If you cannot meet the expectations laid out for you by the administrators, they will get rid of youand find someone else. All of these issues caused their market share to drop. He planned an organizationalchange. Chambers upended the whole operations, its priorities and even its culture. This school has onlybeen open for three years and every year a staff member is out the door because of low performance.Chrysler focus was customer satisfaction and that is the same for the school. Chrysler changed their way of thinking and started working in different ways. The company's refocus took them to a profit zoom of 76%.That changed involved a program of cultural change also. This is a meeting between my superintendent,principle and myself. At this meeting the teachers get their overall rating for the school year. Some topics in

this essay: Accelerated Learning , Toolpack Consulting , John Chambers , System Inc , Inc Chrysler , Bob Lutz , Cisco'sComeback , Chrysler Chrysler , Organization Analysis , organizational change , planned organizational , plannedorganizational change , john chambers , Cisco System , cisco system inc , change organizational , market share , customer satisfaction , driving forces , outside driving , outside driving forces , cars trucks , organizationalculture ,
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