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Health Administration Change Leadership

Health Administration Change Leadership

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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.

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.

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.Health Administration Change Leadership

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.

  • 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?

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. 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. By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria: • o • o o o • o • o 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.Health Administration Change Leadership

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. o 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. • APA Style Paper Template [DOCX]. Required Resources The following resource is required to complete the assessment. • o Ingols, C. & Brem, L. (2016). Case study 5: Ellen Zane—Leading change at Tufts/NEMC [PDF]. In Cawsey, T. F., Deszca, G., & Ingols, C. Organizational change: An action-oriented toolkit (3rd ed.), (pp. 448–479). This case study is the basis for this 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. • o • Kotter, J. P. (2008). Developing a change-friendly culture. Leader to Leader, 48, 33– 38. An interview with John P. Kotter, a thought leader on organizational leadership and change management. This article offers useful insights into Kotter’s perspective on leading change in organizations. Latham, J. R. (2013). A framework for leading the transformation to performance excellence part I: CEO perspectives on forces, facilitators, and strategic leadership systems. The Quality Management Journal, 20(2), 12–33. o • o • o • • •Health Administration Change Leadership

Presents a study based on in-depth interviews of CEOs who led successful organization transformations, that describes a framework for leading the transformation to performance excellence (LTPE). Part 1 explores two of the five categories of concepts within this LTPE framework. Latham, J. R. (2013). A framework for leading the transformation to performance excellence part II: CEO perspectives on leadership behaviors, individual leader characteristics, and organizational culture. The Quality Management Journal, 20(3), 19–40. Part 2 explores three of the five categories of concepts within the LTPE framework. Nelson, K. E., & Pilon, B. (2015). Managing organizational transitions: The chief nurse perspective. Nurse Leader, 13(3), 71–76. Presents the results of a survey to determine how chief nurse officers and chief nurse executives manage change and transitions in their organizations. Challenges at Tufts/NEMC | Transcript. Timeline of Events at Tufts/NEMC | Transcript. Rating the Organization’s Readiness to Change | Transcript. 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. • • • APA Module. Academic Honesty & APA Style and Formatting. APA Style Paper Tutorial [DOCX]. Additional Resources for Further Exploration • o o Cawsey, T. F., Deszca, G., & Ingols, C. (2016). Organizational change: An actionoriented 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. • o o o • 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.Health Administration Change Leadership

Be sure to include: A title page and references page. An abstract is not required. A running head on all pages. Appropriate section headings. 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 • o o o • o o • o 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. 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. o • o o o • o o o • o o • o o o 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?Health Administration Change Leadership

FOR THE USE OF CAPELLA UNIVERSITY STUDENTS AND FACULTY ONLY. NOT FOR DISTRIBUTION, SALE, OR REPRINTING. ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED. Copyright © 2016 by SAGE Publications, Inc. Case Study 5 Ellen Zane—Leading Change at Tufts/NEMC Cynthia Ingols Lisa Brem Simmons College School of Management Boston It was a difficult decision to take this job. But there was something about the history of Tufts-NEMC and its importance to so many stakeholders that really grabbed me as the epitome of what one could do in one’s career. I’d also learned not to be adverse to risks. You have to take risks, not stupid risks, but you have to take risks. — Ellen Zane, CEO, Tufts-NEMC E llen Zane brought a cup of coffee into her home office. It was 4:30 a.m. and she was, as usual, starting the day early. She fired off a few e-mails to her senior staff and looked over the Women’s Business magazine on her desk. Her photograph was on the cover, highlighting the article on the turnaround she was attempting to execute at Tufts-New England Medical Center (Tufts-NEMC). It was the summer of 2006 and it had been an incredibly rough two-and-a-half years since she accepted the CEO position at the ailing Boston hospital. Since then the hospital had survived the worst of its financial troubles—they were meeting efficiency goals and for the first time in years, more doctors joined the hospital than left it. Tufts-NEMC posted an $18 million gain in 2005, after losing nearly $60 million since 2001 (see Exhibit 1 for financial statements). People were smiling and thanking Zane in the corridors. But that was a piece of the problem. This was the tricky part, she thought, in one of her rare moments of quiet as the predawn light slowly infused the room. Zane realized that she was still deeply worried about the future: This place was just so fragile and I still consider it fragile. It’s one month forward and one month back. This market is unforgiving and tough—I swim with the Source: From Linda E. Swayne, W. Jack Duncan & Peter M. Ginter. Strategic Management of Health Care Organizations. Jossey-Bass. 2008. 449 FOR THE USE OF CAPELLA UNIVERSITY STUDENTS AND FACULTY ONLY. NOT FOR DISTRIBUTION, SALE, OR REPRINTING. ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED. Copyright © 2016 by SAGE Publications, Inc. 450   ORGANIZATIONAL CHANGE sharks and nobody glad-hands us. I tell the staff all the time—not a minute do we take our foot off the gas. Zane struggled with how to maintain the solidarity that the financial crisis had created among Tufts-NEMC’s 5,000 employees.1 She knew from her 30 years of experience in hospital management that sustaining change in Boston’s cutthroat medical industry was the hardest part of any turnaround.Health Administration Change Leadership

She had been successful before with Quincy Hospital, but Quincy had been a much smaller player. Tufts-NEMC was a 450-bed Academic Medical Center (AMC) that was the primary teaching site for Tufts University School of Medicine, and conducted over $50 million in research each year. It had 17,000 admissions in 2005 and generated $600 million in revenue. Unfortunately, while Boston’s other AMCs merged, built networks, and grew stronger, Tufts-NEMC had for years floundered directionless in Boston’s rough seas.

As Zane headed to her office overlooking Boston’s Chinatown she wondered: How could she create and sustain true and lasting change for Tufts-NEMC? The Health Care Industry in Boston “Health care, together with education and computer technology, is what Massachusetts is known for throughout the world.”2 Home to several high-profile Academic Medical Centers, the Boston area was a worldrenowned destination for health care services. Massachusetts General Hospital (MGH), Brigham and Women’s Hospital (BWH), and Beth Israel/Deaconess Medical Center were affiliated with Harvard Medical School, Boston University Medical Center with Boston University, and Tufts-New England Medical Center with Tufts. These large AMCs led the way in capturing $2.3 billion in National Institutes of Health (NIH) research grant money, second only to California. Massachusetts hospitals employed 12.2% of the total labor pool, and accounted for a whopping 11.7% of the gross state product. Health care expenditures per capita were between 27% and 29% higher than the national average from 1990 to 2000 (see Exhibits 2–9 for Massachusetts health care statistics). Consumers, health plans, and governing bodies tended to accept that heath care in Boston costs more in accordance with the high quality and cutting-edge services the region provided. Nationally, however, years of underfunding by federal and state governments and rising enrollment left Medicare and Medicaid payments lagging behind surging medical costs.Health Administration Change Leadership

Hospitals in Massachusetts and the rest of the nation amassed significant debt in the 1970s and 1980s as they refurbished older facilities, expanded services, and purchased expensive new technologies. While reimbursements fell behind rising costs, hospital discharges declined sharply in the 1980s, as did the average length of stay. In Massachusetts, a decrease in hospital births and nonresident discharges3 led to an overall decline of 24% in total hospital discharges from 1991 to 1996. The increase in outpatient surgeries also affected hospitalizations.4 Throughout the 1990s, Massachusetts health care insurance plans followed nationwide trends when they merged into three large competitors: Harvard Pilgrim Health Care, Blue Cross/Blue Shield of Massachusetts, and Tufts Health Plan. These “big three” plans wielded increasing power in the marketplace, and their movement to managed health (HMO) plans resulted in lower payments to providers5 and more oversight on costs and medical services. All three expanded regionally, to entice large regional and national companies to offer their plans to employees. HMOs used capitated payments, meaning they reimbursed providers based on the number of “covered lives” in the provider system. Thus, providers of health care services such as hospitals and doctors believed volume

FOR THE USE OF CAPELLA UNIVERSITY STUDENTS AND FACULTY ONLY. NOT FOR DISTRIBUTION, SALE, OR REPRINTING. ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED. Copyright © 2016 by SAGE Publications, Inc. Case Study 5   451 and efficiency of services to be the most important factors in future financial success. In 1991 Massachusetts deregulated hospitals for the first time in ten years. These conditions succeeded in making an impact—threatening the financial viability of hospitals and moving them toward more efficient and cost effective management practices. Boston’s health care leaders struggled for a strategy to survive in the new environment. Mergers, closures, and conversions loomed. The leaders of MGH and BWH made the first decisive move. Managers at both hospitals believed they needed additional leverage to hold their own in negotiations with the ever more powerful health insurance plans. They also envisioned building a network of community primary care and specialist providers who would refer tertiary6 patients to the member hospitals, thus bolstering volume. In 1994, when the news of the merger of these two behemoths—forming Partner’s Healthcare System, Inc. (Partner’s)—became public, it was a seismic change in the landscape of the New England medical industry. Others quickly followed suit. From 1990 to 2000, there were 47 acquisitions and mergers and 19 acute care hospital closures, not including the formation of 10 major hospital systems in Massachusetts.7 Following the market consolidations in the 1990s, the turn of the twenty-first century years were difficult ones for Boston’s hospitals and insurers. Both Harvard Pilgrim and Tufts Health Plans were hindered by regional over-expansion. In 1999, Harvard Pilgrim went into receivership after posting a $226 million loss, while Tufts Health Plan lost $42 million. Community hospitals also continued to struggle from high debt, inadequate reimbursements, high labor and pharmaceutical costs, and failed merger or network integration attempts. In Massachusetts particularly, consumers began to migrate to the more expensive AMCs from the smaller regional or community hospitals, seeking what they perceived to be higher quality of care. Cuts in payments from Medicaid, Medicare, and pri- vate insurance plans continued to plague many providers.Health Administration Change Leadership

To encourage more efficient management and cost containment practices among its providers, HMOs started to move away from capitated care and toward pay-for-performance plans. Even some AMCs felt the pressure on their organizations. CareGroup— another Massachusettsbased hospital umbrella organization—posted a loss of $215 million over 1999 and 2000 and lost market share and network physicians. Partners, however, grew and remained strong, reaching 5,600 doctors in its Partner’s Healthcare System, Inc. (PCHI) network. In a seminal flexing of its market strength, Partner’s negotiated up to 30% increases from all three major health plans, at one point refusing to continue a contract with Tufts Health Plan until it agreed to higher payments.8 By 2005, the provider market was dominated by four major hospital systems: Partners, reporting a surplus of $30 million; Caritas Christi; CareGroup (which had decentralized most of its operations back to its member hospitals); and Boston Medical Center. See Exhibit 10 for provider descriptions. When the dust settled on the consolidation activity, there were approximately 25 acute care, five psychiatric, and five rehabilitation hospitals in the metropolitan Boston area, with Partners leading in market share.9 On the insurer’s side, the major health plans recovered, with Blue Cross/Blue Shield of Massachusetts coming out on top, Harvard Pilgrim regaining strength, and Tufts maintaining a third position. According to one survey of the Boston health care industry, trends through 2005 were: •• AMCs faced lack of capacity from years of merging and downsizing, while admissions moved to AMCs from community hospitals; •• pay-for-performance (quality incentive) programs were gaining in popularity, using .