HA510 Unit 7 Post-Merger Engagement Research Paper Example

Same Workload, Different Losses: An Engagement Research Paper Asking Why Scores at a Composite Health System's Two Critical Access Hospitals Fell Further After the Merger Than at Its Regional Medical Center, Tested Against Two Years of Survey Data

[Student Name]

Purdue University Global

HA510: Organizational Development in Health Care

Unit 7 Engagement Research Paper

[Instructor Name]

[Date]

The system, the survey and every score are composite and bracketed; the vendor's items are paraphrased, not reproduced, and the analysis is a course model.

Introduction

Two years after three hospitals merged into one system, the annual employee survey shows engagement down [eight] points at the critical access hospitals and [three] points at the regional medical center. Workload items, such as having enough staff and time, fell about [four] points everywhere. If workload explained the drop, the sites should look alike. They do not. This paper asks what else changed.

Literature Review

What engagement is. Kahn described personal engagement as people bringing their physical, cognitive and emotional selves to their roles, which depends on three psychological conditions: meaningfulness, safety and availability (Kahn, 1990). Later researchers defined work engagement as a positive state of vigor, dedication and absorption, and developed scales to measure it (Schaufeli et al., 2002). What drives it. The job demands-resources model holds that engagement rises with job resources, such as autonomy, support and feedback, and that demands, such as workload, drive exhaustion rather than directly reducing engagement (Bakker & Demerouti, 2007). Resources can also buffer the effect of high demands. What mergers do. Mergers often change who makes decisions, which leaders are nearby and which routines continue. For staff at smaller partners, that can mean losing decision latitude and local leaders who knew them. Prediction. If the merger reduced job resources at the small hospitals more than at the regional center, engagement there should fall further even with similar changes in workload. The model predicts that losing a say in decisions hurts engagement more than gaining work, which is exactly the pattern the survey shows.

Method

Data: the vendor's annual survey from the year before the merger and the second year after. Response rates were [71] and [68] percent at the regional center and [79] and [74] percent at the small hospitals. Measures: the vendor's engagement index; workload items (enough staff, enough time); resource items grouped into decision latitude (input into decisions about my work, my ideas are acted on), leadership support (my manager supports me, senior leaders are visible) and recognition. Analysis: change in mean item scores by site, on the vendor's 100-point scale. Differences of [five] points or more were treated as meaningful, following the vendor's guidance for groups of this size.

Findings

Engagement index: critical access hospitals down [8]; regional center down [3]. Workload items: down [4] at both. Decision latitude: down [12] at the critical access hospitals; down [2] at the regional center. Leadership support: down [9] at the critical access hospitals; up [1] at the regional center. Recognition: down [2] at both.

Discussion

The pattern fits the prediction. Workload rose similarly everywhere, but resources fell sharply only at the small hospitals, especially decision latitude and leadership support. In the job demands-resources model, those are precisely the resources that sustain engagement. The merger centralized decisions such as scheduling, purchasing and pharmacy coverage, which the small hospitals had made locally. Their administrators now report to a regional vice president and spend more time in meetings at the regional center, which staff experience as less visible leadership. Kahn's conditions add a further reading. Meaningfulness may have fallen when staff no longer saw their ideas acted on. Safety may have fallen when familiar leaders became less available. Neither is measured directly here, but both fit the comments staff wrote in the survey.

What Staff Wrote

The survey's open comments, [212] at the small hospitals, were sorted by theme. The most common were decisions made elsewhere ([58] comments), leaders who are less available ([41]) and workload ([39]). At the regional center, workload came first and decisions made elsewhere barely appeared. One small hospital nurse wrote: "We used to fix things ourselves. Now we send an email and wait." The comments agree with the item scores and add a sense of what the loss feels like.

Links to the Culture Diagnostic

The culture diagnostic in Unit 3 found clan cultures at the small hospitals and a regional center whose managers wanted less hierarchy. The engagement findings fit: a clan culture values local relationships and participation, exactly the resources the merger reduced. The two studies, using different instruments and respondents, point in the same direction.

Alternative Explanations

Turnover could explain part of the drop if the most engaged staff left; the number leaving was similar at all sites. Survey fatigue is possible, but response rates stayed high. A local event, such as a layoff, could explain the drop; none occurred at the small hospitals during the period.

Why Workload Alone Is the Wrong Target

The system's first response to the survey was a plan to add [six] float nurses to reduce workload. That would help everyone, but by the model's logic it would leave the difference between the two kinds of site in place, because the gap lies in resources, not demands. A response aimed only at workload would spend money where the survey shows the smallest difference.

Implications

Restoring decision latitude and visible leadership at the small hospitals should matter more than reducing workload alone. Options include returning small decisions to local administrators, creating local improvement councils and asking regional leaders to spend scheduled time at the small hospitals.

A Test the System Could Run

If returning decision latitude restores engagement, the system could test it. One small hospital could receive authority over a defined set of decisions, such as weekend staffing and minor purchases below a threshold, for a year, while the other continues under the current rules. Comparing the two on decision latitude and engagement items at the next survey would give stronger evidence than this two-point comparison can.

Limitations

The survey uses vendor items rather than validated engagement scales. Changes in site means cannot show causation. The small hospitals' samples are small, so a few responses move the means. Two time points cannot show trends, and a single year may include unusual events.

Conclusion

Engagement fell further at the small hospitals because they lost resources the regional center did not: a say in decisions and nearby leaders. Workload rose for everyone; what the small hospitals lost was control and support. The system's response should aim at those losses first, and test whether restoring them brings engagement back.

References

Bakker, A. B., & Demerouti, E. (2007). The job demands-resources model: State of the art. Journal of Managerial Psychology, 22(3), 309-328. https://doi.org/10.1108/02683940710733115

Kahn, W. A. (1990). Psychological conditions of personal engagement and disengagement at work. Academy of Management Journal, 33(4), 692-724. https://doi.org/10.2307/256287

Schaufeli, W. B., Salanova, M., González-Romá, V., & Bakker, A. B. (2002). The measurement of engagement and burnout: A two sample confirmatory factor analytic approach. Journal of Happiness Studies, 3(1), 71-92. https://doi.org/10.1023/A:1015630930326