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Individual Learning Project

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The chosen contemporary management technique called to help HealthSouth, Inc. achieve the CFSs stated in the previous project about reengineering. This management technique is intended to create a competitive advantage for the company by reorganizing operational and management tasks, so that the jobs carried out will be rearranged into combined, eliminated and modified. The anticipated CFSs include:

  • The profit growth by 1-2% annually.
  • Improved control over the costs and their reduction on all company levels.
  • Enhancing the conditions for rehabilitation and post-acute patients by involving specialists of high qualification and expertise.
  • Meeting the anticipations and requirements set by the patients of HealthSouth, Inc. at each company’s level.
  • Expand the application of accurate FIM (Functional Independence Measure) scores along with corresponding documentation.
  • Preserve excellent patient to staff ratios.
  • Make sure that all the employees have proper education meeting the official state standards for the position.
  • Search for the opportunities to extend the market niche.

Although reengineering sounds more likely to use at the manufacturing companies, however, this advanced management technique is quite useful for other organizations as well. This management technique has been chosen because its application to the healthcare corporation such as HealthSouth will give the company a chance to achieve all or at least many positions in the CFS list. Risky and non-standardized and other medical operations need to be performed faster and better. Reengineering in healthcare is quite different from the usual understanding of this management technique. If reengineering technique is used with reason and wisdom, the risks will be easily eliminated.

The first time reengineering as a concept appeared in the scientific literature was in 1880 when Frederick Taylor inspired his contemporaries to look for the newer and better ways of improving the old processes by means of optimization. In fact, reengineering is about making all business processes the best in the industry. Unlike the nineteenth century, now managers can apply different instruments such as cross-department or cross-functional jobs using the technology enhancements of today (Weicher et al., 2005).

Reengineering management technique stands for empowering the staff and employees to achieve the best results in a good team and not limiting them by their rights and duties. One of the disadvantages of reengineering in business is that it cannot be highly portable and applied to every single sphere. The scope of reengineering is somewhat limited, so it is not a duplicate management theory but a practical technique. Although many companies tend to use reengineering in times of financial and business challenge, it is definitely not a quick-fix method as reengineering used in extreme situations leads to short-term profits cutting the opportunities to produce new products (Berman, 2004).

In order to make reengineering efficient, it is of vital importance to put it into correspondence with the long-term strategy of the company by defining the quantity “milestones”, insuring the strategy is perceived at all organizational levels, defining the capabilities in a realistic manner, and making sure it is linked to the budget plan. If these guidelines are not followed, reengineering will turn out to be a short-term instrument that might bring higher profits tomorrow but leave the company behind in a month or a year. The key to reengineering success is former experience, and in spite of the fact that reengineering often leads to unsatisfactory results for many companies, there is a great amount of information to learn from.

One of the major features in reengineering technique is the great influence of the leader who may even come to the point of ruthlessness when the staff or employees resist the driven changes. But the main goal of such a manager is to fight the fears on the doubts that the employees may feel in the middle and last steps of reengineering. The ambitions should not be concentrated in one single person but should be reflected in the actions of every single employee. Ordering and pressing are not most important parts here, instead, empowering, motivating, guiding and facilitating make reengineering more effective on all organizational levels.

One of the main problems of HealthSouth, Inc. to be resolved by introducing reengineering is the discharge procedure. Obviously, patients who arrive may not have only one disease, and many patients who went through stressful medication have to face complications. In this case, patients have to be discharged and re-hospitalized several times.

The application of reengineering is meant to fight discharge inconveniences and reduce the amount of unnecessary re-hospitalizations. Statistic research demonstrates that discharges bring a range of problems to both patients and “follow-up” hospitals making it quite difficult for every part to say tuned to all the details of the new hospitalization (Forster et al., 2003). Discharge is able to bring multiple discomforts to the patient including injuries and harm. Discharge and re-hospitalization are mutually connected as the first frequently serves as the reason behind the second. Most of the mistakes made by healthcare institutions do not appear because of the poor performance of individual nurses or doctors but they are rather the consequences of systematic mistakes (Kohn et al., 2000).

The reengineered discharge system might include the following stages: educating the patients about their conditions, medications and therapies; communicating the unresolved problems at the moment of discharge; checking on the medication therapies after discharging; checking on the overall patient condition after discharging. Possible methods of resolution may be taken from business including problem mapping, assessment of the risk probability, cause deep analysis, qualitative interviewing, and failure mode and influence analysis.

Process maps will allow managers to gather and accumulate the most relevant information about the existing processes. Qualitative interviewing is related to the deeper understanding of people’s life goals. This method is used to evaluate what the employee’s attitude towards decision making or organizational shifts is. It is a contrast to the qualitative side of the question focusing on relationships, people and sociology instead of figures, profits and economics. Failure mode and influence analysis is a quality improvement process that analyzes the expected and unexpected errors of the discharge process, as well as their probability and possible consequences. Each significant failure mode has an action plan for elimination of the negative outcome. Root cause analysis complements the approach mentioned above – it identifies the causes behind re-hospitalization in order to make up preventive measures. Those causal factors have to be related to processes and systems only but not to individual performance. Common causes of organizational errors in healthcare will result in developing an overall organizational system that fights such negative outcomes.

Team building is another important concern of the healthcare management when it comes to reengineering. The company should make a good try develop multidisciplinary teams that conduct different aspects of the project. The advisory group inside the multidisciplinary team will consist of the chief medical officer, statisticians, senior researches, computer specialists, medical center directors, and the officers responsible for nursing, patient service, quality improvements, and case management. This group is supposed to meet monthly and discuss the strategic reengineering and ensure the sustainability of the major working processes. On the other hand, the working group may meet weekly and include statisticians, health service researchers, nurse manager, abuse counselor, pharmacist, inpatient team directors, and administrative staff leader. The working group should use both group and individual in order to conduct the following tasks situated below.

Along with the discharge enhancements, it is reasonable to incorporate FIM score systems that the nursing personnel may use to fix all the patient’s needs and peculiarities. HealthSouth, Inc. is going to direct its attention to proper documentation of the patient’s outcomes in each area of specialty. This documentation is crucial to insurance payments as well as appropriately gauging the patient. Accurate documentation of FIM is a tool used by the therapist and nursing to demonstrate progress made or lack thereof. If a patient is scored too high this reduces the burden of care upon the facility, thus, insurance repayment is reduced and the patient may require a discharge before fully functional. By ensuring that one therapist oversees the care of a maximum of three patients the FIM will be more accurate in describing the burden of care and forward accomplishments the patient is making. As well, the nursing staff grades the patient separately from therapist. Due to the fact some of these patients are status post trauma, orthopedic surgery, failure to thrive and etc. the nursing to patient ratio should be set according to acuity of patients. This allows the nursing staff the time needed to care for wounds, surgical equipment related to the patient and encouragement. Sources deciding these issues must monitor patient outcomes based on daily FIM scores. By breaking down the traditionalism of organization, reengineering puts the patient in the center of the company’s system of values. This humane-oriented approach is of particular importance for the healthcare mission. Healing the human body for the salvation of the human soul is what all medical institutions are about. Being a service organization, HealthSouth, Inc. may put all its commitment and efforts to customer satisfaction as reengineering places the patient’s needs as the foremost priority. Due to a number of strict rules and hierarchical principles that bound the freedom of action, it may be quite challenging for the employee to do his best for the patient. As soon as the employees are granted with the authority to adapt to the changing circumstances, make exceptions and complete operations with some extra resources. The speed of service is vital for healthcare service, as sometimes it is a human’s life that the organization is responsible for.

Customer care and satisfaction is a true measure of the patient’s treatment and care that was experienced by him or her while in the hospital setting. HealthSouth, Inc. has historically had average remarks and scores with Press Ganey. Press Ganey enlightens many medical organizations to patient viewpoints on care while hospitalized (2012). The patients are generally mailed a survey after discharge and asked to rate the organization on areas of a patient to staff relations. This particular area is broken down into department specific areas of physical therapy, occupational therapy, speech and nursing staff. This allows the patient to grade each area of expertise within the hospital. As well, the nursing department is broken down further to include such as items as timely answer to call light, professionalism and courteous. The sources at HealthSouth are most interested in the grading that is applied in these areas mostly due to the overall outcome a patient will relate his or her stay to others. The goal the company has set for itself is 90% and this is analyzed each month then finalized quarterly.

Robert Janson separates three fundamental principles that build up the foundation for reengineering at any service organizations:

  • Claiming the customer the company’s starting to change point by defining his necessities and desires and supporting their realization with the corresponding infrastructure.
  • Tune the global organizational goals to the current working processes.
  • Rearrange the familiar working patterns for supplying all the necessary resources for top-class front performance (1992).

One of the best examples of incorporating flexible teamwork in healthcare institutions is Cleveland Clinic where the high-quality enhancement program that united the medical specialists of all kinds embracing psychologists, neurologists, surgeons, and internists organized for those patients who are trying to recover from severe diseases and organ systems malfunctioning (Arnst, 2010).

According to the results revealed in Individual Learning Project 1, the majority of the issues of HealthSouth, Inc. management are related to the human resource management. If the organization investigated – just like HealthSouth – is not about asset portfolio but is rather a strong team of highly-motivated people working together to provide quality services, human resource is one of the crucial aspects to consider in reengineering (Ettore, 2005). Reengineering the human resource in HealthSouth should be pointed against high turnover rates, morale decrease, shallow team devotion and lack of security and insurance provided. One way to conduct it would be introducing a constant information exchange flow that moves throughout the company and touches upon the most anticipated results and hidden dangers of the reengineering. It is crucial to stress out teamwork values and the benefits of cooperation. Nevertheless, it does not mean that the salary bonuses should be tied to the profits or to the team performance as those are the factors that are beyond the employee’s control. Such system has already been involved by the Capital Holding Company (Weicher et al., 2005).    

Moreover, no reengineering effort succeeds without further retraining and reeducating the employers that will be most closely connected to the reengineering process. Reengineering breaks the traditional views on hierarchy and labor division theory values, so if the manager is going to put more responsibilities and move the flow of information down, it is crucial that people know how to react and to act for the benefits of the organization. The manager should also be able to fight employees’ the doubts and fears (for instance, “My experience is not worth anything with this new technology”, “I am going to lose my job”, etc.) by communicating his own perspective, plans, vision, opinions. The leadership style should be switched into democratic regime, and some of the management responsibilities may be delegated to the middle and lower levels of power. Apart from the atmosphere of optimism, empowerment, trust and mutual respect, the manager should take care of the employees’ insurance.

The example of GTO, Inc. headed by the new CEO Chuck Mitchell shows that persuading the employees in the efficiency of the new plan and the splitting decision making among the lower levels of authority are not that difficult and costly as it seems at first glance (Weiher et al., 2005). Such positive measures will also lead to staff turnover decrease. Judging the research results revealed in the previous project, the focus of HealthSouth should not be on the processes but rather on the corporate culture and human resource although a better audit system should be introduced as well.

The implementation plan for HealthSouth will consist of the following steps:

  • Introducing new computer accounting system to record FIM, keep the track of the cost management and the patients’ needs.
  • Providing a new discharge and re-hospitalization system with less procrastination and troubles for the customers.
  • Uniting the divisions into one compact unity created for the best customer comfort.
  • Providing better insurance and coverage opportunities for the employees.
  • Involving the specialists with high qualification and expertise to deal with rehabilitation patients and the cases of increased difficulty.
  • Retraining the existing staff to comprehend the innovative systems of accounting trying to fight their fears and doubts.
  • Developing the speed of service attained due to the newer accounting systems and more “compact” service as a competitive advantage.
  • Introducing corporate culture morale: giving bonuses to the employees, who stay loyal to the company, make great contributions to the organization’s progress; emphasizing the goals of HealthSouth, Inc. and saying the CFS aims “out loud”; cultivating personal commitment and tuning the individual’s interest to the interests of the entire organization.
  • Putting the values of humanism, love for the patients and customer care as the foremost priority.

Therefore, reengineering at HealthSouth is called to:

  • Increase the profits by 1-2% annually thanks to more satisfactory rates among customers and reduced costs resulting from involving multiple specialists from different fields, discharges and re-hospitalizations.
  • Improve the cost control throughout the organization during to improved information systems invented for any organizational levels.
  • Reeducate and retrain all the specialists involved in the reengineering process including high-expertise doctors and those who deal with post-acute and rehabilitation patients.
  • Improve the level of healthcare service by creating combined and conjoint operations for greater speed and quality.
  • Make sure that the employers on each level of organization are committed to the purposes of the entire organization due to the emphasis on company’s values and goals as well as the benefits the employers receive in result.
  • Involve technological advancements and more sophisticated equipment to track the Functional Independence Measure scores along with the existing documents.
  • Decrease the employee turnover by motivating people to follow the general purposes of reengineering, offering beneficial conditions of work, cultivating corporate culture values and upbringing long-term devotion, belief in the higher mission and humanism.
  • Provide reeducation programs for all organizational levels marching in step with the development of chemistry, pharmacy, equipment and science.

There must be explicit delineation of roles and responsibilities. Information must flow easily throughout the organization, so that the feedback may be received by the original sender. Information should be captured throughout the hospital stay all the time. Documentation should cover follow-up care details, risks, anticipated issues, and other essential data. All patients should have access to their discharge information in their naïve language and adapted to their educational level.

Reengineering technique is the essential tool to develop the company’s flexibility both using human resource and assets for achieving the stated CFSs. By bringing together a multidisciplinary team to apply several quality control methods, high risk patients are identified, the essential aspects of the discharge process are pointed out, and the sources of error that can impact on outcomes are determined. The methods diversity applied to help HealthSouth to achieve its CFSs faster has given the researcher a deep insight into the complexity and integrity of the issues in medical treatment.

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