1. Measurements of Organizational Culture
1.1. Organizational Culture Survey: Denison Organizational Culture Model (DOCM)
1.1.1. History: Beginning in 1998, Denison’s global practice grew from a set of diagnostic assessments, rooted in research linking organizational culture and leadership to business performance. The global team builds on this base of expertise to provide a full-range of transformation services designed to deliver impact to our clients. Our success comes when we contribute to our client’s improved performance.
1.1.2. Purpose: "Boost the performance of organizations by improving their corporate culture and leadership."
1.1.3. Usage in Healthcare Organization: Hospital, employee, and patient surveys from 87 Chinese public hospitals conducted during 2009 (HSR Article); In this cross-sectional study, 177 employees in administrative units of health care centers in the cities of Hamedan Province were selected by a multistage stratified sampling method. The data collection instruments included the standardized Denison organizational culture survey and organizational commitment questionnaire by Meyer and Allen. Data were analyzed by IBM-SPSS version 21 using descriptive statistics and Pearson product-moment coefficient. (NCBI Electron Physician) Relationship between organizational culture and commitment of employees in health care centers in west of Iran
1.1.4. Outcomes: Identify areas of cultural strength and weakness. Troubleshoot points of internal friction Back up your culture initiative with hard data. Measure your culture improvement over time. Strengthen your business performance. Create a culture that will attract and retain quality talent. Utilize additional valid and benchmarked assessment modules to explore: employee engagement, employee commitment, innovation, trust, and safety and risk management.
1.1.5. Validity: Validity of the DOCS has also been supported. In Cho’s (2000) work, exploratory and confirmatory factor analytic results such as a confirmatory factor index (CFI) of 0.99, suggest a robust construct validity of DOCS scales and items. Denison and colleagues’ (2005) study also demonstrated validity of the DOCS. Confirmatory factor analysis showed a root mean square of approximation of 0.048 and CFI of 0.98. Their data support the theoretical structure implied by the DOCM. Consequently, a strong link between organizational culture and performance (effectiveness) is supported, and these studies together suggest the DOCS has robust psychometric properties.
1.1.6. Reliability: The DOCS is a valid and a reliable tool that has been used extensively to measure the culture of various organizations for nearly 2 decades. Extensive psychometric testing conducted by Cho (2000) using a sample of 36,542 raters from diverse organizations showed coefficient alphas ranging from 0.70 to 0.86 for the 12 indices (scales) and from 0.87 to 0.92 for the four culture traits, indicating acceptable levels of consistency within scales.
1.1.7. Description: The Denison Model links organizational culture to organizational performance metrics such as Sales Growth, Return on Equity (ROE), Return on Investment (ROI), Customer Satisfaction, Innovation, Employee Satisfaction, and Quality.
1.2. Innovation Characteristics
1.2.1. Empowerment
1.2.1.1. The OCAI survey points to a collaborative culture of empowerment and the Denison survey reinforces empowerment with the decisions being made at the level where the best information is available. Empowerment is such a critical piece to innovation. If individuals aren’t empowered to make decisions and individually advance progress innovation can be seriously hampered. This hampering could happen because there is a bottle neck in the decision making hierarchy that causes delays when everything needs to be run through a limited number of decision makers, or because when there is a limited number of decision makers it takes away the collaborative strength of a varied team with different viewpoints and strong suits. Empowering the makers to be decision makers allows innovation to move forward quickly and efficiently, while utilizing the strengths of a collaborative team.
1.2.2. Employee capability and technical knowledge
1.2.2.1. The JSTOR survey points to technical knowledge and the Denison survey points to the capabilities of people being viewed as an important resource of competitive advantage. Skilled employees are a requirement to achieve innovation. Without the skillset to develop or advance the innovation it would not be possible to succeed. Along with this is acknowledging the value of employees and the value that their skillset and knowledge base brings to company, and recognizing them for the valuable asset that they are and not an expendable or replaceable commodity.
1.2.3. Collaborative Culture of Organizational Coordination
1.2.3.1. The Denison survey outlines the need for it to be easy to coordinate projects across different parts of the organization and the Innovation-Point survey outlines the need for support from above and within so that leadership supports a collaborative culture that encourages different departments working cross-functionally to identify and develop new innovations and solutions. Having a collaborative culture where teams across the coordination can easily contribute to innovation is paramount for the advancement of innovation. Often times innovation requires multiple skill sets or departmental contributions to come to fruition and it cannot occur in a vacuum or an environment where the appropriate resources are inaccessible.
1.2.4. Flexibility
1.2.4.1. The Denison survey emphasizes that in creating change it is helpful when the way things are done is very flexible and easy to change. If an organizational structure or culture is too rigid it can impede innovation. If that structure is severely inflexible and can’t adapt to accept the changes required by innovation then there would not be overall adoption, or the process would not be allowed to move forward because of the lack of willingness to change. Flexibility allows the organization to be nimble and quickly and fully adopt changes needed for innovation to realize the benefits there in.
1.2.5. Adoption of New Ways to Work
1.2.5.1. The Denison survey highlights the benefit when new and improved ways to work are continually adopted. An environment and culture where new ways to work are readily adopted paves the way for innovation. It is much easier to implement new or updated technologies or processes identified by innovation when the organization is accustomed to regularly adapting the way they practice to accommodate improvements.
1.2.6. Failure is viewed as an opportunity
1.2.6.1. The Denison survey calls attention to the need to view failure as an opportunity for learning and improvement. With any advancement or innovation, there is always a risk for failure. When that failure is viewed as a learning opportunity then it allows for growth and new knowledge development during the process, and allows the team to proceed forward more informed as innovation continues. When failure is viewed too severely it could impede innovation because individuals and the organization as a whole could be afraid to move forward
1.2.7. Risk taking
1.2.7.1. The OCAI survey details the need to create a culture where visionaries are inclined toward risk, and not afraid of uncertainty. The Denison survey likewise emphasizes that innovation and risk taking are encouraged and rewarded, while the JSTOR survey points to the criticality of the managerial attitude toward change. Risk taking is at the core of a successful innovation process. A culture that is risk-adverse does not allow for the advancement of innovation, but a culture that embraces appropriate risk levels allows innovation to be pursued and flourish while acknowledge the risk involved.
1.2.8. Adequate resources
1.2.8.1. The JSTOR survey mentions ‘slack resources’ while the Innovation-Point survey mentions organizational resources and the need for the organization to have adequate staffing, funding, leadership, and cross-functional management support to successfully identify and implement new ideas. Innovation consumes resources just by the nature of creating something new, and adequate resources are a requirement for innovation. Those resources could come in multiple forms such as time, staffing, physical supplies, or fiscal needs. Overall, having a healthy organizational structure and adequate resources can beneficially contribute to innovation.
1.2.9. Formalized Innovation Process or Roles
1.2.9.1. The Innovation-Point survey identifies if an organization has dedicated resources and formalized process focused on identifying and developing both incremental and breakthrough innovations, while the OCAI survey outlines creating a culture with specific roles like entrepreneurs and visionaries. By implementing formal processes or dedicating formal roles to innovation, it solidifies the importance of innovation within the organization as well as being a formal vehicle to allocate the resources necessary.
1.2.10. Clear and Consistent Values
1.2.10.1. The Denison Survey measures the existence of a clear and consistent set of values that governs the way we do business. Having clear and consistent organizational values helps innovation by assuring that everyone focuses their innovation in directions that fit in with the overall organization philosophy and that will advance the purpose and mission of the organization. Clear and consistent values is an item that enables empowerment, because if everyone is striving for the same end-goal then that is when empowerment can be practiced at its fullest knowing that the decisions made are in line with the values that have been set forth.
1.3. Instrument Analysis
1.3.1. Description: The Denison organizational culture survey provides a comprehensive yet easy to understand analysis of the cultural dynamics of your organization which is linked to your current performance
1.3.1.1. Strength: Clear and concise, fast and easy to implement, measures group behaviors, written in "business language" , measures link between behaviors and business results, applicable to all levels of organization; focuses on the balance among cultural elements.
1.3.1.2. Weakness: Survey looks at general behavior of a nursing unit, rather than a tangible measure, like organizational performance.
1.3.2. Underlying Theory: The Denison Organizational Culture Model - Four Specific Traits: Adaptability, Involvement, Consistency, and Mission
1.3.2.1. Strength: Similar to the completing values framework The link between the culture measures and effectiveness outcomes were central to the development of the survery. Their model proposes that it is not only possible for an organization to display strong internal and external values and the capabilities for both stability and flexibility, but that the most effective organizations are those that display “full” profiles as indicated by high levels of all four traits (Denison, 1990).
1.3.2.2. Weakness: In her review, Sackmann (2011) describes how the wide variety of survey instruments used makes it difficult to establish clear patterns across studies, instead creating “a rather broad and colorful picture of the link between different culture dimensions and performance measures” (p. 196).
1.3.3. History of validity and reliability: confirmatory factor index (CFI) of 0.99, suggest a robust construct validity of DOCS scales and items
1.3.3.1. Strength: The scales of the DOCS have been examined using both reliability analysis and confirmatory factor analysis. Coefficient alphas range from .70 to.86 for the 12 indexes and from .87 to .92 for the 4 traits, indicating scientifically acceptable levels of consistency within scales. Factor analytic results support the hypothesized structure of the DOCS (60 items making up 12 indexes, which themselves make up 4 culture traits). These results indicate that an organization’s culture, as measured by the Denison Organizational Culture Survey, is directly related to its performance. Recent studies have demonstrated predictive validity across industry and national boundaries.
1.3.3.2. Weakness: Descriptive instruments typically focus on the internal reliability and validity of the survey measures. In addition to this form of validity, effectiveness instruments must also demonstrate that the dimensions are linked to organizational effectiveness. Thus, effectiveness measures are generally more focused than descriptive measures, retaining only those dimensions with a strong theoretical or empirical linkage to effectiveness outcomes (Ginevičius & Vaitkūnaitė, 2006; van der Post et al., 1997). Effectiveness instruments are also normative. Purely descriptive instruments may remain value-neutral, but effectiveness instruments must be rooted in a theory of how specific behavioural norms and values lead to higher effectiveness. The need for more longitudinal research, better effectiveness measures and more of them, larger and more representative samples of organizations, and cross-cultural validation remain at centre stage.
1.3.4. Beliefs: The culture of the organization has a strong influence on organizational effectiveness.
1.3.4.1. Strength: Core beliefs align with team beliefs. One Review identified the DOCS as the most well-researched effectiveness instrument to date. Overall, the results of these analyses offer support for the psychometric integrity of the Denison Organizational Culture Survey as well as the survey’s link to organizational effectiveness.
1.3.4.2. Weakness; Should measure Organizational Culture on Nursing Units not solely on group performance (Excellent, average, poor). Staff Nurses might be mindful of their personal OC rather than being a part of the nursing unit group. Survey needs to be cognizant of individual factors that could impact global OC as a unit.
1.3.5. Usage in organizations: Over 5000 companies worldwide for over 25 years
1.3.5.1. Strength: Strong bench-marking analytics; They used data from a large and diverse sample of 35,474 raters who had voluntarily completed the DOCS between 1997 and 2001. These data were obtained from an archive consisting of both public and private sector organizations including large Fortune 100 companies, schools, and private small companies.
1.3.5.2. Weakness: Not healthcare specific; cross country/cultural limitations. The culture indexes and traits also have a large degree of intercorrelation,suggesting that—in general—respondents tend to perceive the business units as effective overall or not effective overall.
1.3.6. Advantages: Measures group behaviors rather than their personality. Designed and created within the business environment rather than within the academic environment. The items are written in “business language” and therefore are suited for exploring and interpreting business-level data. Measures the link between group behaviors and bottom line business results. Fast and easy to implement. Applicable to all levels of an organization.
1.3.6.1. Strength: Correct measurement. Trending data. Well understood. Speed. Scalable.
1.3.6.2. Weakness: Xenikou and Furnham also suggest that the broad themes identified in their research may provide a useful basis for developing new scales. Ashkanasy et al. (2000) describe some of the tradeoffs between simple and more complex models.
1.3.7. Limitations: To date, the use of the survey as conceptual framework for nursing unit’s organizational culture research is limited. Dependent on response volume.
1.3.8. Usefulness of the information generated: Trends and patterns in results: Organizational Strengths and Weakness in percentiles compared against normative database. Line item in-depth report with granular review of each question. High/Low Report provides 5 highest/lowest scores - Trends/Patterns in results
1.3.8.1. Strength: Actionable reporting
1.3.8.2. Weakness: Comparing Healthcare organization to non-healthcare organizations
1.3.8.3. Weakness: Could dilute focus depending on implementation tactics
1.3.9. Team Recommendation: We would recommend this survey for our organization as it's a validated tool that can be used to help identify opportunities and strengths in our organizational culture. Additionally, eight of the ten best innovation behaviors were captured in the Denison Survey.
1.4. Guidelines for selecting and using surveys to evaluate innovation behaviors or tendencies
1.4.1. Select the correct KPI (key performance indicators) to evaluate the areas where innovation is most needed in your organization.
1.4.1.1. Rationale: By being intentional about the KPIs you survey about, you are setting the tone of what you are choosing to measure. "Choosing the correct KPIs for measuring innovation is necessary because you usually tend to get what you measure. Your goals and KPIs direct your efforts and actions towards them and help people to adapt their behavior as well as take action to reach those goals." If you don't tailor your survey to your organizational culture or the culture you are striving for, it will be difficult to know what innovation needs to happen and the areas that need extra focus to implement change.
1.4.2. Understanding what your input and output metrics are.
1.4.2.1. Rationale:To understand if a survey is effective you must understand what your input and output metrics of innovation are. You should be able to know the work you are putting into innovation and what changes are coming as a result of that. "Input metrics measure if you’re doing enough activities of the right types to reach your goals, whereas output metrics measure whether these activities have had the desired impact." By tailoring your survey in a non-leading way to ask in a survey, you can clearly identify what areas need improved for innovation and what areas are on the right track because of the work you have already done.
1.4.3. "When designing or planning a survey, the most important step is to clearly define the question to be answered by the survey results. A survey is most effective if its purpose can be clearly and succinctly stated. Surveys with vague or overly‐broad motivations can become too lengthy or difficult to analyze. Also, a survey may not be the best way to answer your question; focus groups are an example of another research method that may be useful in certain contexts."
1.4.3.1. Rationale: By understanding the "why" as to why the survey is taking place, you can form clear, non leading questions to analyze in your survey. It is important to also analyze if there are any other tools that already answer the questions you are asking in the survey so staff do not feel survey fatigue and are more willing to be honest.
1.4.4. Don't limit your survey to only concrete data.
1.4.4.1. Rationale: When it comes to measuring innovation, don't get hung up on choosing or tailoring your survey to something that will only give you concrete data. For example, financial measurements are great to use but there could be missed opportunity in an survey if that is the only focus or the only focus are on items that will give you a "yes or no" answer. The opportunities that are missed in these instances could be staffs ideas on how to improve culture, customer service initiatives and more.
1.4.5. Develop a review strategy.
1.4.5.1. Rationale: By developing a review strategy, staff will feel their answers were valid and heard. Create a review strategy before the survey goes out so analysis can begin right away. This prepares for the aftermath of the survey results. Create a survey focus group, analyze the results, put forth innovative plans to implement the information from the survey and continue to have the focus group follow through on the changes going forward to measure the changes and impacts.
2. Strategies to Advance Innovation in Organizational Culture
2.1. Positive Strategies
2.1.1. Recognize that friction or conflict is inevitable and must be explored and integrated into the culture
2.1.1.1. Rationale: We must respect individual voices and value inclusion of ideas. Teams must work through conflict to toward a shared vision. A critical component of institutional change is negotiation among the conflicting values and diffusion of conflict over value priorities
2.1.2. Engage informal leaders whenever possible to be courageous, resilient and creative as ambassadors of the desired cultural behavior and norms
2.1.2.1. Rationale: Allow staff to participate in projects, workflows and panels allows for deeper levels of employee engagement. Employees who are able to contribute to new, fresh ideas are energized and have a new sense of loyalty and pride in the organization. The pride and loyalty can be infectious throughout an organization and can help staff believe that their contributes truly make a difference to the organization and that their ideas are valued.
2.1.3. Transformational leadership - Leadership that inspires followers to change expectations, perceptions, and motivations to work toward common goals. Even if leadership only has partial buy in, it will tie in the strategy of only needed less than 30% of a group or organization to begin a movement.
2.1.3.1. Rationale: This strategy allows leaders to articulate an effective vision, motivate staff, empower subordinates and give staff an opportunity to individualize their impact on the organizational culture. This will also help to engage informal leaders to be ambassadors of change and potentially encourage collaboration between cross-functional areas.
2.1.4. Be Future Focused by having a clear strategy that is clearly communicated
2.1.4.1. Rationale: Ultimately all innovation is a result of being future focused, and seeing the potential and benefit of what can be in the future if investment is made in a potential solution to an issue.
2.1.5. Take advantage of the natural tendencies of groups and individuals. Look to your natural leaders to pave the way of change. They will be your early adapters to your innovation processes and get other group members on board. Give your employees some freedom to be independent and form their own culture.
2.1.5.1. Rationale: By fostering relationships with your natural leaders, they will feel more confident in leading the change of culture.They will have leverage in getting their peers on board for innovative changes and can get buy in from staff. When you give them the freedom and more responsibility, these changes will begin to occur naturally.
2.2. Strategies to overcome resistance to change and innovation in healthcare influence change
2.2.1. Be flexible and practice good timing when implementing innovative ideas
2.2.1.1. Rationale: Change fatigue can be a result of too many innovations changes taking place too close in proximity to each other. Aligning innovations with other priorities can lead to low attention or participation. Inability to be flexible in this situation either due to specific activities or training timeline can derail a new idea.
2.2.2. Engages in deep dive experiences to foster creativity
2.2.2.1. Rationale: Provide staff an opportunity to have a dedicated space and time to collaborate and create in a safe environment. The freedom to create, and 'spread your wings' and to fail, can provide organizations with new ideas and workflows that may have never been realized in a traditional work model. "The innovation center trend began in technology-based industries, but is expanding as companies increasingly face “next generation consumer needs,” says Aravind Chandrasekaran, associate professor of operations and associate director of the Center for Operational Excellence at Ohio State University’s Fisher College of Business. He says it helps companies have “ambidexterity” and work on incremental innovation ideas while separating out a lab to look for the next big idea in their own and other industries."
2.2.3. Be open to accepting failures as opportunities by allowing flexibility in implementation of new ideas.
2.2.3.1. Rationale: One of the reasons humans are resistant to change is an assumption that if he/she is unable to address all problems or failures, other will assume he/she is not smart and may be viewed as incompetent. This often results in resistance to taking a risk to implement change. If the organizational culture is one that allows staff to feel safe to try, fail and try again, you will see a decrease in resistance to change.
2.2.4. Ask the Best Questions
2.2.4.1. Rationale: Asking the best questions is vital at all points in the innovation process, and is particularly critical when overcoming resistance or addressing issues. By asking the best questions, the innovator can be sure to arm themselves with the best and most thorough information to understand the situation and inform the appropriate approach for the next steps forward. Asking the best questions is also important because when you ask questions of others you can understand their thoughts surrounding the innovation, proactively address any concerns, and when other parties feel heard and understood they are much to likely to positively contribute to the innovation process and not be as resistant to any new change. No leader or innovator comes into any situation with all of the knowledge needed, but often what is important is the ability to ask the right questions at the right times to get the right information.
2.2.5. Research what your competing commitments are within your organization to better understand the resistance. Dig into the underlying assumptions to be able to find this competing commitment and ask yourself how can I flip this to a positive.
2.2.5.1. Rationale: Employees can be resistant to change for a wide range of reasons so getting to the root of that resistance is key. By digging into what the specific fear is, you will be able to use it to your advantage to instill the change. Take an employee who may say "This is just going to make my job harder" and understand they probably feel overwhelmed. Take the time to show them that the change can lead to more meaningful work that may be less tedious.
3. Cultural Characteristics and Behaviors
3.1. A characteristic unique to healthcare is the Hippocratic oath.
3.1.1. Underlying Assumptions
3.1.1.1. Non-Maleficence = do no harm. Our actions will create minimal harm to the patient, the benefits will outweigh harm.
3.1.1.2. Autonomy: We will respect patient's decisions about their own health.
3.1.1.3. Justice: We will distribute medical benefits and services fairly.
3.1.2. Values
3.1.2.1. Non-Maleficence: We will do our best to prevent patients from falling while at the hospital and report any falls that do occur.
3.1.2.2. Autonomy: We will allow and encourage patients to make their own choices around their medical treatments and hospital stay.
3.1.2.3. Justice: We provide medical benefits and services to all people.
3.1.3. Artifacts
3.1.3.1. Non-Malefience: Call light is within patient's reach. Bed Rails are up. Non-Skid Socks applied.
3.1.3.2. Autonomy: Patient's are given menu's to choose their own meals, have the opportunity sign or refuse a consent for treatment or procedures, HIPAA
3.1.3.3. Justice: Insurance Benefits are applied to patient accounts, Payer/Hospital Contracts are in place and followed for insured patients, payment plans are offered for outstanding balances, self pay discount and HCAP/Financial Assistance Programs offered
3.2. Decision Making in an ICAS -A decision recently made in our organization was to allow staff to work exclusively from home due to COVID-19. This decision was an emergence from the need to adapt to the COVID-19 pandemic and the new conditions the organization was experiencing. Multiple characteristics contributed to this decision, and multiple groups were impacted.
3.2.1. Impacted users
3.2.1.1. Staff
3.2.1.1.1. Lack of commute and parking
3.2.1.1.2. Hours worked
3.2.1.1.3. Internet connectivity or dropped calls
3.2.1.1.4. Disruption from individuals at home
3.2.1.1.5. Onsite work required for testing and validation
3.2.1.1.6. Separating work time from home time
3.2.1.1.7. Account for childcare
3.2.1.1.8. Happiness/Satisfaction
3.2.1.1.9. Office with windows!
3.2.1.1.10. Proximity to free food
3.2.1.1.11. Set a more flexible schedule
3.2.1.1.12. Mental breaks with family members/walks
3.2.1.1.13. Movement throughout the day
3.2.1.1.14. No morning rush
3.2.1.1.15. Impromptu human interations
3.2.1.1.16. Access to office supplies
3.2.1.1.17. Increased appointments
3.2.1.2. Management
3.2.1.2.1. Increased productivity
3.2.1.2.2. face time with staff
3.2.1.2.3. Emergence of Management/Leadership Huddle Meetings
3.2.1.2.4. Team availability
3.2.1.2.5. Loss of general observation
3.2.1.2.6. Improved Communication Strategy
3.2.1.3. Clinicians
3.2.1.3.1. Lack of physical IT services
3.2.1.3.2. New remote mobile technology
3.2.1.3.3. Emergence of Telehealth
3.2.1.3.4. Increased technical aptitude to join appointments
3.2.2. Characteristics
3.2.2.1. 1. Shared purpose: The organization was committed to maintaining high quality health care, while taking all possible measures to keep patients, staff, and faculty safe during the pandemic. Many aspects of the organization underwent change, but it was all with the shared purpose of quality healthcare and safety.
3.2.2.2. 2. Selectivity: When leadership in the organization was considering measures to take during the pandemic, there was a lot of information to consider. This included information from the Governor’s office, the CDC, our own internal experts, as well as many other sources. It was critical to consider all appropriate information related to healthcare, but they did not need to consider information specific to things like retail areas or exercise facilities etc.
3.2.2.3. 3. Permeable boundaries: There are always permeable boundaries for an ICAS, and the decision to allow staff to work from home increased that. Staff now had varying physical locations, different levels of technology, other family members present during work time and many other disparate variables. The increased ‘surface area’ if you will of the organization impacted and increased the permeable boundaries of the ICAS.
3.2.2.4. 4. Flow: This characteristic was the epitome of the decision to allow exclusive work from home. The organization could not stagnate with the new and changed parameters around a safe work environment, and the decision was a result of the motion of the ICAS to achieve the goals and shared purposes.
3.2.2.5. 5. Multidimensionality: Multidimensionality was required on several levels for this decision. It was necessary to take in multiple perspectives to make the decision to work from home. Additionally, while implementing the decision multiple perspectives were required to decide on the best methods and options to implement the decision.
3.3. Loop Learning with Telehealth
3.3.1. Single Loop: Telehealth has to be implemented so create a Telehealth visit type so patients can still be in communication with their providers.
3.3.1.1. Telehealth visit type were created without asking questions by turning on a setting in MyChart to allow video conferencing.
3.3.1.1.1. We solved this issue without asking questions as there was a requirement from the governor to stop any non essential or emergent appointments or surgical cases. While this was the correct decision to turn on video conferencing within MyChart, questions should have been asked to ensure all patients had access to Telehealth.
3.3.2. Double Loop: Patients who did not have MyChart or access to a computer were not able to have a Telehealth visit or a way to be seen during the pandemic.
3.3.2.1. IT and providers worked to identify all possible scenarios that would be needed for telehealth. It was identified we needed to create visit types for patients who had access to a camera or smartphone but did not have MyChart and patients who did not have access to a computer. From that, we decided to ask the question during scheduling if patients had access to a camera or smartphone. From there, we would schedule either through MyChart or a third party video vendor that is HIPAA compliant. Telephone visits were created for patients that did not have access to a camera or smartphone.
3.3.2.1.1. We solved this issue by asking why we needed these additional visit types and the answer to that was so that all patients could have access to Telehealth. We believe this was the correct answer to this approach as it would not exclude patients who did not have MyChart or lacked access to the proper technology.
3.3.3. Triple Loop: The MyChart application was not as intuitive and had constant issues.
3.3.3.1. When working with the physicians, we were hearing feedback that the UpDoxx application (the 3rd party video vendor) was better than MyChart. MyChart would crash, was not as intuitive, and slowed down the process of treating patients. Some providers began to use Zoom, which is not HIPAA compliant because the application was better. They asked why they could not use the 3rd party application, UpDoxx for video visits instead of MyChart. We found there would be no harm in allowing the physicians to use UpDoxx if they preferred to use that instead of MyChart even if patients had a MyChart account and we would leave it to the provider to decide. We gave all providers access to this application.
3.3.3.1.1. We solved this issue by listening to feedback from clinicians and allowing them the autonomy to choose which application they prefer. We provided them with an option that allowed us to continue to be HIPAA compliant and feel this was the correct answer to the problem.
4. Definition of Culture
4.1. The assumptions, values, and artifacts of an organization that comprise the distinct social and psychological environment which have been established, reinforced, and conveyed over time via shared experiences.
4.1.1. Theory Based Definition
4.1.1.1. Amplified by the behaviors of leaders
4.1.1.1.1. OSU Slidedeck: Week 2 Organizational Culture Definitions
4.1.1.2. Embedded in a network of organizational practices
4.1.1.2.1. OSU Slidedeck: Week 2 Organizational Culture Definitions
4.1.1.3. Shared beliefs, values and assumptions held by members fo the organization
4.1.1.3.1. OSU Slidedeck: Week 2 Organizational Culture Definitions
4.1.1.4. Visible in the way that work gets done on a day to day basis
4.1.1.4.1. OSU Slidedeck: Week 2 Organizational Culture Definitions
4.1.1.5. Evident in the behaviors of individuals and groups
4.1.1.5.1. OSU Slidedeck: Week 2 Organizational Culture Definitions
4.1.2. Assessment of Definition
4.1.2.1. Artifact: Consistent reoccurring collaboration as a group through meetings, emails, texts and project assignments.
4.1.2.1.1. Theorist: Edgar Schein theory of Levels of Organizational Culture
4.1.2.2. Value: Alignment
4.1.2.2.1. Theorist: Edgar Schein theory of Levels of Organizational Culture
4.1.2.3. Value: Empathy
4.1.2.3.1. Theorist: Edgar Schein theory of Levels of Organizational Culture
4.1.2.4. Value: Vulnerability
4.1.2.4.1. Theorist: Edgar Schein theory of Levels of Organizational Culture
4.1.2.5. Assumption: Our group has an underlying assumption that we trust each other to complete our team work in a timely manner.
4.1.2.5.1. Theorist: Edgar Schein theory of Levels of Organizational Culture
4.1.3. References
4.1.3.1. Edgar Schein theory of Levels of Organizational Culture
4.1.3.2. OSU Slidedeck: Week 2 Organizational Culture Definitions
5. Course Project
5.1. Issue: Communication within teams and between work units is ineffective in this organization.
5.1.1. Identified challenge summary: Traditionally communication has always been a vital yet challenging component of successful organizational culture. With the rapidly advancing complexity and increasing rate of change in organizations the challenge for adequate, clear, and concise information dissemination has become exceedingly difficult. In the most recent cultural engagement surveys a significant decrease in the perception of communication was noted. This includes both communication within teams, as well as visibility and communication between work units. When staff sense a lack of communication it results in confusion, a lack of engagement, and can ultimately cause the staff to be less vested in the work being done and the successful completion of projects if they are unsure how they align with overall goals and visions.
5.1.1.1. Identified solution summary: We are proposing the implementation of a Visual Management Board (VMB) as well as regular standing meetings within teams to review these boards. The goal would be a visual representation of what each team member is working on that is quickly consumable and understood by the entire team. These management boards can then 'bubble up' to higher levels with the high impact items being represented for other teams to improve communication between work units as well.
5.1.2. Supporting Evidence: insights based on employee feedback. key performance indicators with comparisons to a database of health care workforce insights
5.1.2.1. Culture Engagement Survey 2017
5.1.2.1.1. Favorable 54% Neutral 23% Unfavorable 23%
5.1.2.2. Culture Engagement Survey 2020
5.1.2.2.1. Favorable 44% Unfavorable 56%
5.1.3. Principles of organizational culture
5.1.3.1. Align vision and action: "Alignment-focused interventions are many and varied, and include those that improve the “consistency of plans, processes, information, resource decisions, actions, results and analysis” (Lukas et al., 2007), and require leaders to explicitly plan for impacts on frontline staff and clinical care."
5.1.3.2. Promote Staff Engagement: "Staff engagement occurs when people feel listened to and are able to have a real impact on the change process (Saul et al., 2014)
5.1.4. Measurement approaches: To measure the success of this implementation we propose a use of both formal and informal measurement tools.
5.1.4.1. Team meeting feedback: As an informal measurement method we propose soliciting feedback during the team meetings where the VMBs are reviewed. Though unofficial, there is often a lot of valuable information that can be gathered by listening and soliciting feedback.
5.1.4.2. Survey monkeys: As a next level of validation we could also develop a questionnaire to be distributed via survey monkey at specific intervals to measure any improvement in the perception of communication. Though our survey monkey questionnaire would not be a fully vetted and tried measurement model, it would need to be developed with a mindset to maintain as much reliability and validity as possible. It would be critical to know what we were trying to measure via the survey tool and have well defined KPIs, and know what input/output mechanisms we expect. This includes developing the questions in a non-leading manner, being clear in the verbiage used, and identifying the metrics that we truly want the survey to represent so we know what we expect back in return. By using this survey method at specified intervals after implementation we would have numerical data to review that would highlight areas of improvement or concern.
5.1.4.3. Future organizational culture surveys: Our final metric would be comparing the communication scores from our organizational cultural survey that we take every two years. This is a fully validated and reliable tool implemented and administered by an industry leader in engagement surveys. The goal would be statistically significant improvements in communication scores in the areas that implemented the VMB model.
5.2. Strategic Plan: Visual Huddle Board
5.2.1. Purpose
5.2.1.1. In order to enhance our communication, we need to be transparent about what everyone is working on. One of the purposes of this Visual Huddle Board is to have a quick glance at all of the open projects and who is assigned to them. Staff can build up an animosity and experience burn out if they feel their plate is too full. It is easy to feel you are working harder than the person next to you. By having this visual huddle board, staff are able to see that work is evenly distributed. This also assists management in knowing work is evenly spread.
5.2.1.2. This process promotes collaboration between teams. There can be times when a team is doing a project that another team may be interested in but didn't know it was happening. By having all of this information visible, other teams are able to look and see what projects and initiatives may be coming up that affect their workflow or are an enhancement they would like to make.
5.2.1.3. Another purpose of the visual huddle board is to keep all staff and departments "in the know". It is easy to think that everyone is on the same page but by having all information in one place to look at, staff do not have an excuse to say they did not know a deadline of an upcoming project, required follow up, or
5.2.1.4. Have this be used by multiple departments so staff have a place to go to to know who to reach out to about issues that may involve other teams. Many times there are hold ups because staff say they didn't know who to reach out to. This promotes staff Independence in finding this information on their own instead of waiting for a manager to give follow up of a name or contact information.
5.2.1.5. An innovative way to replace unnecessary email communication.
5.2.2. Key Stakeholders
5.2.2.1. Staff- It is staff responsibility to update their portion of the board with what projects they are working on. It is also their responsibility to look at the huddle boards each day so they know deadlines, upcoming important dates, etc.
5.2.2.2. Leadership- Leadership is in change of championing this communication initiative. They will create and oversee one for their specific team and encourage their staff to utilize this tool.
5.2.2.3. Other Departments- One goal of this initiative is have all departments use this tool. By having multiple departments using this, it will be more transparent of what departments are responsbilble for what.
5.2.3. Timeline
5.2.3.1. After the intial roll out plan, we would like to monitor the progress and affectiveness of our 3 month plan, outlined below. If this is successful, we would like to expand to a broader audience after month 3. This would go to all teams in IT and can be shared with end users (clinical teams, patient access services, etc.) if we find success.
5.2.3.2. We would like to roll this board out ASAP to all teams. A template is already in place and management would just need to update the information with their specific teams names, projects, key dates, etc. This is a shared document so it can be updated by anyone on that team.
5.2.4. Communication Strategies
5.2.4.1. Identify change leaders in our organization and gain buy-in using strategies identified
5.2.4.2. Present plan to management team and share expected outcomes from the initial pilot. Seek feedback and challenges from the different business units
5.2.4.3. Develop Staff communication plan including Q&A or FAQ. Details must include how the visual management boards increase communication across business units.
5.2.5. Expected outcomes
5.2.5.1. Promote staff engagement. Allowing staff to feel listened to and being able to have a say on change processes.
5.2.5.2. Foster distributed leadership. Refocus of top down leadership, to allow opportunities to have more bottom up leadership.
5.2.5.3. Align vision and action. Ensure that staff understand (communication) the vision and are adequately supported to help reach goal.
5.2.5.4. Create collaborative interpersonal relationships. Foster a culture that places importance on collaboration and teamwork.
5.2.6. Measurement/evaluation plan:
5.2.6.1. A review strategy would need to be developed before implementation of this tool or feedback was solicited to be prepared to assess the success of the VMB and meetings. We would review feedback from all of our measurement methods regularly. Upon evaluating the feedback obtained via team meetings and survey monkey results we would look for areas that need improvement. When the survey results show increased effectiveness and perception of communication we would look to share the VMB method with additional work areas in the organization to expand its impact. If surveys and feedback show no improvement or a decrease in communication there would need to be conversations on the benefit of continuing the tool and if it should be discontinued, but ultimately we do hope the measurement of feedback would show this tool to be beneficial.
5.2.7. Accountability Expectations
5.2.7.1. Leaders will create a safe environment to allow social construction to evolve
5.2.7.2. All team attends and actively participates in the huddle
5.2.7.3. Leaders take any issues or communication up to management huddle as well as report any information that should be communicated to the team from the management huddle
5.3. Sustainability plan
5.3.1. Month 1
5.3.1.1. Positive Strategies
5.3.1.1.1. Team huddles on a regular basis to allow collaboration and communication. The huddles should be no more than 30 mins and at least 2 times per week.
5.3.1.1.2. Create a visual management board (VMB) to facilitate the discussion at the huddle and act as a status board for all teams to be able to access at any given time.
5.3.2. Month 2
5.3.2.1. Positive Strategies
5.3.2.1.1. Evaluate the level of engagement from the team through direct observation of the huddle participation and made changes where necessary to overcome
5.3.2.1.2. Evaluate the VMB updates and effectiveness through direct observation
5.3.2.1.3. Leaders will identify and seek engagement from the informal leaders.
5.3.2.2. Accountability Expectations
5.3.2.2.1. Team members area actively updating the VMB and coming to the huddles prepared to share information or provide collaborative feedback to others on relevant topics
5.3.2.2.2. Add a red, yellow, green indicator for communication levels. Allow the team to rank the communication level on a weekly basis to help measure the effectiveness of the VMB and huddles
5.3.3. Month 3
5.3.3.1. Positive Strategies
5.3.3.1.1. Determine improvement opportunities to allow for Huddles and VMB to continue to develop
5.3.3.2. Accountability Expectations
5.3.3.2.1. Measure if projects are completed with less 'misses' or issues because of unknown changes. Measure if fewer off cycle changes occurred post implementation
5.3.3.2.2. Resurvey team members to determine if communication scores increased
6. Group Number 5
6.1. Andy Comes
6.1.1. Evidence and Communication
6.2. Samantha Gilbert
6.2.1. Purpose, Stakeholders, and Timeline
6.3. Stacey Roth
6.3.1. Sustainibility
6.4. Sharon Schauer
6.4.1. Organizational Culture and Outcomes
6.5. Jennifer Williams
6.5.1. Measurements