Introduction

The journey of transformational change in New York General Hospital started when the hospital was the center piece of the severe acute respiratory syndrome (SARS) disaster. According to Hayden & Denison (2008), SARS brought trauma and tragedy to the New York General Hospital community. On the other hand, it brought the need and opportunity for the renewal and revival of the institution. In response, Colling and York (201) pointed out that New York General Hospital invested significant  energy and time in building up an organizational culture where all the staff members of the institution understood that initiatives of change  are created at the health care systems front lines, where the staffs collective wisdom drives the required changes, and where all members of staff in an institution feel safe in learning their mistakes, and understand well their part in maintaining, inspiring and implementing the momentum. The essay will discuss how New York General Hospital used cultural transformation, as a change management framework in bringing transformational change. Cultural transformation change in New York General Hospital has seen the organization collaboration, teamwork, leadership and efficiency.

SARS epidemic in New York General Hospital

According to Canada & Federal-Provincial Advisory Committee on Institutional and Medical Services (2014), about three years ago, the journey of transformation of New York General Hospital began when SARS catastrophe struck. SARS is a lethal virus that is unknown. The catastrophe hit hospitals in Toronto, attacking patients, staffs, members of their families and physicians, and this impacted so much on many staffs and even some lost their lives. Oandasan & Canadian Health Services Research Foundation. (2010) pointed out that the chief executive officer of New York General Hospital, Bonnie Adamson even said that during the SARS disaster, they saw the best out of human beings and also the outcome when trust is eroded. SARS left their staffs feeling disengaged, unhappy, lacking trusts, and unsafe in the organization.

New leadership platform

Tyshenko  et al (2010) pointed out that despite New York General Hospital being hit by the SARS catastrophe, the leaders of the institution came to learn that their members of staff were true heroes  and very brilliant. They learn that the ordinary people can perform extra ordinary things if given the necessity or the opportunity to do so and that their staff had the ability under pressure to self reorganize themselves. Moreover, they came to learn that perceptions of safety and quality can be influenced by relationships, and that the old thinking ways and behaviors needed to be changed.

The top leadership brass saw the time as an opportunity for fundamental transformation, rebirth and growth. The entire organization needed to make an investment in building their internal capacity, improve trusts levels, and become more resilient across the organization. The New York General Hospital embarked on a journey that would see them transform and rebuild the organization in cooperation with the front line staff, formal leaders, the board, and the physicians, the safest possible environment for highest quality of health care and for the patients (Marshall, 2011).

Phase one:  cultural leadership transformation (change driven strategy)

After listening for many hours to the New York General Hospital managing directors, staffs, patients, community members and families, the top level team was able to make a description of the current reality of the institution, their future state desired and the existing gaps that needed attention. Based on the two way feedback and the input, New York General Hospital came up with an organizational strategy. A workable plan was designed with four themes in a balanced score card that is driven strategically with quadrants of cause and effect. The team then came up with leveraged actions to address the gap, besides both quantitative and qualitative indicators to monitor their progress (Boonstra, 2013).

According to Colling and York (2010), the team felt that the execution of the strategy depended on change driven strategy of cultural leadership transformation. Epicenter of the transformation was a decisive plan move away from their current state to the future state that is desired. To realize that, the organization concentrated on shifting from the blame culture to accountability, from bosses to being coaches, from control and command  to stewardship, from silos to systems, and from individuals to teams. This shift can only take place with a steady leadership that is aligned with the strategy and direction of the organization. Moreover, Canada et al (2014) observed that the institution recognized that their leaders and managers needed new skills and capacities to reach their vision. Therefore, working sessions and leadership development   for their leaders became significant. The CEO led the in- house sessions, and regular meetings for all the leaders and their 120 managers of the organization. Furthermore, through regular learning sessions and dialogue, the senior leaders provided input for the 120 leaders of the institution (Oandasan et al, 2010).

Tyshenko et al (2010) observed that with the new thinking way, cross functional and new skills management infrastructure, a commitment to change of culture, strategy design and execution became the new method of doing business. The organization newly empowered and energized embarked on a journey to develop several improvement initiatives.

Marshall (2010) indicated that regardless of priority or project, it is a challenge to sustain change for a long time. Quick address to problems are generally accomplished  by adding skills or resources, but results of quick fix cannot be sustained ad maintained until the organizations culture including  values, norms, thinking and behaviors, language, shifts truly to continuous improvement culture. The leadership of New York General Hospitals acknowledged that meaningful and sustainable changes could not occur and be sustained in any part of the organization without over bending old culture transformation and support of the broad organization. They made the transformation culture a top priority.

Placing culture as the foundation, New York General Hospital was able to execute the change that is strategy driven. Each and every change could be observed through the strategic model of alignment, which aligns structures and skills with culture and strategy. Boonstra (2013) pointed out that one of the seventeen transformation process was the ED/GIM project in the organization, and it showed how crucial the organizational cultures for the sustainability of the success. The ED/GIM is an example that shows the cultural transformation efforts of New York General Hospital led to improvements in the institutions internal general medicine and emergency department. Colling and York (2010) asserted that because the process transformed team development and dynamics, the organization believes the model of transformation will enable the introduced changes persists for a long time.

Phase two: multiple changes implementation

Other efforts of transformation were directed at management infrastructure development that was essential to momentum rejuvenation while translating, executing, engaging and motivating the staff using the bottom-up model. As the leadership, culture and strategy became aligned, the newly energized and empowered organization got on a journey to launch many improvement initiatives for the organizational process.

Before engaging in many activities for improvement, Canada et al (2014) pointed out that the institution was on its way well towards realizing the leadership cultural transformation successes. Oandasan et al (2010) observed that the third annual New York General Hospital culture survey showed sustained improvement in consecutive year in all areas of culture of the organization including innovation, learning, leadership and management styles, contribution, recognition and team work.

Execution of strategy focused on engaging the whole organization in the adoption of continuous learning philosophy, cross unit alignment and daily improvement. This culture then led to multiple process transformation adoption using a Rapid Improved Events referred to as Kaizens, and Lean Toyota. In the ED/GIM area, an analysis of eight value stream, 3 vertical value streams, 20 kaizen events, and 3 causes and effect event analysis have been conducted since 2006 October. Tyshenko et al (2010) indicated some of the successes of ED/GIM and they include:

  1. 49% increase in patients number
  2. 52% time reduction from when a patient leaves from a bed and to when it is available and ready for the next patient
  3. 27% reduction in length of stay of a patient for sub- acute patients
  4. 86% time reduction from the assignment of a abed from a leaving patient to the next.
  5. 73% time reduction in bed assignment to when the patient gets on the bed
  6. 19% time reduction from patient arrival to discharge at the emergency department.

Marshall (2011) asserted that the staffs, who build on their current skills and knowledge, were translated and adopted easily for other initiatives, hence increasing the organizations internal capacity. Boonstra (2013) indicated that throughout phase two, New York General Hospital has used projects like the improvement efforts of ED/GIM in promotion of organizational learning and strategic alignment. One of the strengths of efforts of transformation has been the dedication of the informal and the formal leaders at all organizations levels. Every member of the organization from top to bottom has been empowered as a vehicle and leader for change and action.

Through common language and framework dedication, participants in every level are able to see how the values, mission and vision of the organization can be translated from the ideas in boardroom to realities. Furthermore, the improvement events also provide opportunities for capacity building in the organization

Although the organization has introduced right mechanics, many transformational changes have failed because they have not put the right people in their right roles, and given them right tools. The physicians at New York General Hospital have played a key role in development and execution of organizational change and transformation (Colling & York, 2010).

Phase three: sustaining changes

New York General Hospital has plans to deploy many approaches to sustain improvements in the whole organization. These include different sustainable management infrastructure elements, including using the strategic management system and balanced scorecard, expanding usage of Kaizen and methodologies of value stream across the organization, in addition to building of new skills in intuition, leadership and decision making (Canada et al, 2014).

From the onset, New York General Hospital believed balanced scorecard ensures sustained improvement and strategy execution. It is important in tracking right metric set and in cascading dialogue in an organization. The four themes of the score card include; family and patient driven care, clinical and operation excellence, responsiveness, and partnering and leading in system transformation. This forms the accountability basis for all leaders and all the efforts of transformation.

Conclusion

In conclusion, through application cultural transformational framework, New York General Hospital has transformed over time in the face of SARS catastrophe. The leadership, efficiency, team work and collaboration the organization displayed saw them recollect themselves in the face of a disaster to transform into a new organization. The change was realized because of the wise stewardship of the leaders, staffs learning from their mistakes and playing their role in inspiring and implementing the change momentum

 

 

 

 

References

Boonstra, J. J. (2013). Cultural change and leadership in organizations: A practical guide to successful organizational change.

Canada., & Federal-Provincial Advisory Committee on Institutional and Medical Services (Canada). (2014). Addiction services in hospitals: Guidelines for establishing standards for special services in hospitals, report of the Sub-Committee on Special Services in Hospitals. Ottawa: Health Services Directorate, Health Services and Promotion Branch.

Colling, R. L., York, T. W., & Colling, R. L. (2010). Hospital and healthcare security. Amsterdam: Butterworth-Heinemann.

Hayden, F. G., & Denison, M. R. (January 01, 2008). Antiviral Agents for SARS. 184-202.

Marshall, E. S., & Marshall, E. S. (2011). Transformational leadership in nursing: From expert clinician to influential leader. New York, NY: Springer.

Oandasan, I., & Canadian Health Services Research Foundation. (2010). Teamwork in healthcare: Promoting effective teamwork in healthcare in Canada : policy synthesis and recommendations. Ottawa, Ont: Canadian Health Services Research Foundation.

Tyshenko, M. G., Paterson, C., & Canadian Electronic Library (Firm). (2010). SARS unmasked: Risk communication of pandemics and influenza in Canada. Montreal [Que.: McGill-Queen’s University Press.

 

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