NU708 Unit 3 7-S Organizational Assessment Example

Ready in What It Believes, Not in How It Works: A Unit 3 Organizational Assessment of a Hospital Before Spreading an Insulin Discharge Bundle

[Student Name]

Purdue University Global

NU708: Advanced Systems Leadership: Transforming the Health Care Organization

Unit 3 Organizational Assessment

[Instructor Name]

[Date]

The hospital, its leaders and its figures are composite and illustrative; the frameworks cited are real.

The Change Being Assessed

The bundle requires five things for every patient starting insulin: an observed first self-injection using the pen that goes home, a written plan without jargon, dispensing of that pen as soon as insulin is ordered, contact with the patient within three days of discharge and a booked place in the outpatient class. On 5 West and 6 West, during a six-month pilot, 30-day returns for glucose problems among patients on new insulin fell from about one in seven to 9 of 104, a little under one in eleven. These are illustrative pilot figures, too few for firm conclusions. The question for this assessment is whether the rest of the hospital, eight more inpatient units, is organized in a way that will let the bundle work there.

The Framework

Waterman et al. (1980) warned leaders against equating an organization with its chart. They proposed seven interdependent elements that must fit one another for a strategy to take hold, placing shared values at the center and arranging strategy, structure, systems, style, staff and skills around it. Their point was that changing one element without the others produces a well-designed change that does not take. Bolman and Deal (2017) reach a similar conclusion by another route, urging leaders to look at any organization through several lenses at once, including a political lens on who holds power, because most leaders habitually use only one. The 7-S model is used here because its elements map well onto the bundle's requirements, and the political frame is borrowed where the 7-S model is thin.

Element by Element

Strategy. The hospital's three-year plan names readmission reduction as one of four priorities, and diabetes is listed among the target conditions. The bundle fits the strategy directly.

Shared values. The mission statement and nursing's professional practice model both emphasize patient education and safe transitions. Staff surveys show strong agreement that teaching is part of nursing's role. The bundle fits.

Skills. Staff nurses on most units are experienced in insulin administration, though fewer have taught a patient to self-inject from the first dose, and the pilot showed that a one-hour session plus two observed demonstrations was enough to teach the return-demonstration method. The skills gap is modest and easily closed.

Staff. There is one diabetes educator for 260 beds, and the position has been vacant twice in five years, each time for several months. Follow-up contacts on the pilot units were made by the educator and two trained staff nurses on light-duty days. Spreading to eight more units would roughly quadruple the volume of contacts. Staffing fits only partly.

Style. The chief nursing officer has publicly backed the pilot. But the hospital's management style around beds is directive and daily: the morning bed meeting sets discharge expectations unit by unit, and a manager who slows discharges must explain why. That style pulls against a bundle that may hold some discharges for a demonstration. Daily discharge targets can move behavior quickly, as one two-unit project raised discharges before noon more than threefold through checklists, afternoon rounds and daily feedback (Wertheimer et al., 2014), which is exactly why the bed meeting's expectations will shape how units treat the bundle.

Structure. The bundle crosses four departments, nursing, pharmacy, hospital medicine and outpatient education, with no single owner. On the pilot units, the project lead coordinated informally. Structure fits poorly for spread.

Systems. Systems are the largest misfit. The electronic record has no field for a completed return demonstration, so it cannot be required or reported. Pharmacy's workflow dispenses discharge medicines after the discharge order, which delays pen teaching. Readmission reports reach unit managers quarterly. And the scheduling system books the diabetes class only on Tuesdays.

The hospital wants the result the bundle produces, but its systems are built to produce the opposite.

Evidence From the Pilot

The pilot itself gives some evidence on fit. On 5 West, where the manager adjusted the assignment so the nurse doing a return demonstration had one fewer patient that day, 49 of 52 patients on new insulin completed a demonstration with their own pen. On 6 West, where no assignment change was made, 38 of 52 did. Pens arrived from pharmacy before the last day for only 21 of the 104 patients, because the dispensing rule was unchanged. Those two numbers show the pattern the assessment describes: where a local leader changed a system, the bundle held; where the system stayed the same, it slipped, even on a pilot unit with an engaged project lead.

Reading the Pattern

The pattern is a familiar one. The "soft" elements, shared values, skills and strategy, are aligned with the bundle; the "hard" elements, systems and structure, are not. Waterman et al. (1980) noted that hard elements are often assumed to be easy to change, when in practice they carry the organization's habits. Bolman and Deal's political frame adds one more point: the bed meeting is where real power over discharge timing sits, and a change that does not win there will be overridden there, whatever the strategy says.

Recommendations

The assessment recommends fixing systems and structure before adding units.

1. Build a return-demonstration field and a readiness flag into the electronic record so the bundle can be required, tracked and reported.

2. Move pen dispensing to the day insulin starts, through an agreement between pharmacy and nursing.

3. Name a single owner, a nursing director with a pharmacist and a hospitalist co-lead, accountable for the bundle hospital-wide.

4. Add a monthly report of insulin returns by unit to the bed meeting agenda, so the style of daily control has the data that would make it support the bundle.

5. Fund a second diabetes educator or trained follow-up nurses before the third new unit joins, using the business case planned for Unit 6.

Conclusion

The hospital is ready to spread the bundle in what it wants and believes, and in what its nurses can do. It is not yet ready in how it is organized and how its systems work, and a change that depends on four departments with no owner and an electronic record that cannot see it will fail on unit three or four. Fixing those elements first gives the bundle a fair chance across the organization.

References

Bolman, L. G., & Deal, T. E. (2017). Reframing organizations: Artistry, choice, and leadership (6th ed.). Jossey-Bass.

Waterman, R. H., Peters, T. J., & Phillips, J. R. (1980). Structure is not organization. Business Horizons, 23(3), 14-26. https://doi.org/10.1016/0007-6813(80)90027-0

Wertheimer, B., Jacobs, R. E. A., Bailey, M., Holstein, S., Chatfield, S., Ohta, B., Horrocks, A., & Hochman, K. (2014). Discharge before noon: An achievable hospital goal. Journal of Hospital Medicine, 9(4), 210-214. https://doi.org/10.1002/jhm.2154