Not for profit organization, HealthCo, is a large healthcare organization comprising a network of hospitals, affiliated clinics, and specialized units across the eastern seaboard of America. A large proportion of nursing and patient care, allied health services, and support staff across the HealthCo network are female. Given women account for 78% of the healthcare industry labor force, the lack of gender diversity at HealthCo is unsurprising (Bellstrom, 2015).
Three situations involving work-life balance, boss-subordinate relationship and organization culture confronted some of HealthCo's senior staff in the weeks leading up to a session on current issues and strategy with CEO, Dr Palmer. Concurrently, the Human Resource (HR) team brought the topic of employee retention, specifically HealthCo's high turnover rate, to Dr Palmer's attention. The worrying issue of HealthCo's high turnover, 1.5 times the industry average, coupled with recent coverage of Fortune “Best Companies to Work For”, piqued Dr Palmer's interest in the importance of work-life programs and policies in leading companies. Sensing the competitive advantage that the addition of work-life programs may add to the HealthCo business, Dr Palmer put forward the idea at the senior staff meeting and received mixed reactions. Recounting HealthCo's branding that “our employees are HealthCo”, Dr Palmer sought volunteers from senior staff to develop a plan to become a “top company with respect to work-life benefits” (Cummings & Worley, 2015, p. 522).
Issues with human resource systems (employee retention, flexible scheduling, work-life programs and policies), management processes and structure at HealthCo emerged during Dr Palmer's discussion with his senior staff. Applying only workforce diversity and wellness interventions, one component of organization design (OD), to this situation would be an ineffective solution to what clearly involves broader OD issues and requires further diagnosis of the HealthCo organization.
In order to assist the senior planning team with their project, a representative from HR should be involved and/or available to act as an internal OD consultant. It is unclear from the case study the exact role HR has played within the organization, however given the senior staff discussion on work-life issues elicited such a heated debate, it may be fair to say there has been limited proactive engagement until now. That or the fact that Dr Palmer may have been unresponsive to HR issues, showing somewhat of a bias frame to his leadership style. If HR does not have the skillset to advise on OD, it would be recommended to engage an external consultant to work with the senior team in their planning.
In consideration of the costs to conduct a diagnosis of the situation, Dr Palmer acknowledged that HealthCo's financial performance would permit discretionary spend for workforce diversity and wellness interventions. However, noting that HealthCo is a not for profit organization costs of the diagnosis and any subsequent interventions should be managed.
Dr Palmer pointed to a survey that had been undertaken of female attitudes to work life-benefits at HealthCo. For the purpose of this analysis, it will be assumed that the survey is recent within the last couple of years. The benefit of using this survey in the diagnosis is that the costs have already been absorbed in an earlier budget and the results for analysis can be quantified. However, one disadvantage of using these results for inclusion in the diagnosis is that males were not included in the survey population. When addressing the topic of work-life, one must consider a myriad of factors in the diagnosis, most notably age, gender, race, sexual orientation, disability, culture and values. As such, the weak survey design must be considered in reviewing these results.
One method to collect data in this diagnostic phase at HealthCo would involve conducting a survey or questionnaire (quantitative methods). The target audience would include a broad cross-section of the 6,700 workforce, questions would focus on climate within the organization with the aim of determining workplace stressors that are causing the high turnover at the organizational level and cognitive and subjective consequences such as potential burnout and anxiety. This method would be less expensive, could garner responses from a broader population sample than before and it could be designed to account for gender, age, race, family situation, job level/seniority and HealthCo location.
The OD consultant could then work with the planning team to assess the results and identify issue areas where they could focus the next phase of the diagnosis. This stage could involve focus groups where the team can sound out their identified issue areas, and could then do a deep dive in areas that need further unpacking. The benefit of conducting interviews and/or focus groups rather than relying on the survey that has been conducted before is that the questioning may delve into areas raised in the survey to gain a more updated view and is likely to produce more rich data. The fact that these interviews will be in person will also allow the interviewer to develop rapport with the employees with the aim to create a more relaxed setting conducive to chatting more freely. Furthermore, initial results from the survey could be used in discussions with the senior staff to provide initial insight on the issues and gain their feedback and input. This could form part of a progress update but with a more specific intent of revealing to senior staff what is actually going on beneath the surface at HealthCo. Presenting a situation with facts and figures to the VP of Finance is most likely the best way to deliver communication that he will receive, it is speaking his language.
After conducting a diagnosis of the situation in more detail, the OD consultant could then determine if there is strategic alignment within the organization and thus assess the level of organization effectiveness in the areas of performance, productivity and stakeholder satisfaction.
Diagnosis of the situation at HealthCo
The CEO identified employee retention as an issue. He recognized the inconsistency between HealthCo's marketing messages and how the organization is living its core values. Although the trigger for Dr Palmer's interest in employee retention was the high turnover rate at HealthCo, the recent media coverage of Fortune's “Best Companies to Work for” with few health care companies listed is evidence of external environment pressures and opportunity for a review of the business strategy. His eagerness to make HealthCo a “top company to work for” in terms of work-life demonstrates his commitment to initiate a change process. However, planning for and developing a work-life program and policies in isolation to the whole organization system would be limiting.
In the ensuing discussion with senior staff, it became clear that senior management had unsympathetic, biased and/or inconsistent views towards work-life balance. The discussion revealed not just work-life balance issues but broader organization culture and structural tensions within groups. This was evident from Pat's attitude that his staff should work the hours needed, no question and that “they would never be coddled this way in a law firm” (Cummings & Worley, 2015, p. 522). Similarly, the VP of Finance was equally frustrated with the suggestion of work-life considerations and revealed his distrust and bias in employees potentially being allowed to work from home. This was not necessarily an issue of technology, although that may play a part, but more the VP's personal fears about control of his team, transparency and accountability. Being a healthcare organization with various locations, front line and corporate roles, and time constraints a major pressure in some areas such as the 24/7 lab, work scheduling also emerged from the discussion as a concern that needs to be addressed at a group level with input from broader stakeholders. The heated debate also revealed senior staff's hesitation and readiness for change, while also showing positivity from the Nursing Director's comment about shorter, split shifts, and longer shifts to create flexibility, that collective discussion on these issues with stakeholders in the right environment may produce benefits for the organization.
Across the three scenarios there is evidence of individual, group and organizational workplace stressors. At the individual level, Chris and Pat both acknowledge the high workload, though Pat shows clear signs of a lack of appreciation for the different work environment of a not for profit compared to a Washington DC law firm where he previously worked. Furthermore, he shows insensitivity in not recognizing Chris' contributions to accommodate Sidney's 12-week parental leave on top of his own workload and family commitments. The stress that Pat is displaying and the blame he is apportioning to Chris for not agreeing to go away on a work trip and irritation with Sidney's absence on parental leave relates more to task structure issues within the group (workload, potential understaffing, work design), group composition (Pat's expectations of the team's work ethic) and team functioning (Chris' growing reticence about working for Pat and the prospect of other jobs). Pat's myopic view of how his team should function and his attitude to contingency planning with workflow issues in Sidney's absence shows areas of personal development that needs addressing. Specifically, his personal values and beliefs appear at odds to the organization's values “that our employees are HealthCo” (Cummings & Worley, 2015, p. 522). The result of the earlier survey indicates the role and relationship of the supervisor and the subordinate was vital in supporting the employee's ability to balance work life and derive satisfaction (Cummings & Worley, 2015, p. 521). The behavior demonstrated by Pat and the high turnover rate is symptomatic of OD design issues which points to lower organization effectiveness in the area of stakeholder satisfaction, notably employee satisfaction.
The scenarios with Francis and Blair and Mercer and Robin reveal inadequate or non-existent HR policies that address workforce diversity. Results from the earlier survey rank leave specifically maternity/paternity and family leave and sabbatical/extended leave as the two most important work-life balance benefits for female employees. The scenario with Francis and Blair shows this is not an isolated issue for females alone. Both Francis and Mercer display interest in being able to support their team but have limited HealthCo resources or avenues in addressing the situation, resulting in a degree of stress for both managers. Mercer's estimation of HR's reaction to Robin's proposal suggests the role of HR at HealthCo has been lacking and not receptive to alternative ways of doing things. However, the fact the Mercer appears to be considering options for Robin is positive.
Research (survey and questionnaire) would need to be undertaken to assess the workforce diversity at HealthCo to determine if there is likely to be family planning situations like Blair, Chris and Sidney, cultural issues for consideration of leave, inadequate representation of females in senior positions and succession-planning issues, similar to Robin's case that will emerge in the coming years. This would complement the diagnostic methods mentioned in the first section of this case analysis.
Key Issues at HealthCo
For HealthCo to become a top company in terms of work-life balance, the CEO, senior staff and employees must believe in and have commitment to the organization's values. This goes to the heart of what the organization is about and if individuals or groups are acting out behaviors not in line with these values, organization outputs such as performance, productivity and stakeholder satisfaction will suffer. This is evidenced through the scenario of Pat and Chris as an example.
By asking the senior staff planning team to develop a plan to become a top company, Dr Palmer is essentially asking them to tweak parts of the organization's strategy. Addressing workforce diversity or structural issues such as group composition, task functions in departments like legal or the lab, in isolation is piecemeal and a band aid solution. The main issues that HealthCo needs to address in a holistic perspective are workforce diversity (human resource systems), organization culture, and group design. These three elements are interconnected and thus to address each issue it would be more effective to review the organization strategy of HealthCo in light of external competitive pressures and ensure Dr Palmer's goal of implementing a human resource intervention is in strategic alignment.
HealthCo's workforce is disproportionately skewed to women in job profiles that may be considered the core of HealthCo's service delivery, that is nursing and patient care, allied health services, and support staff. As such, issues related to women and family will always be a major consideration in workplace diversity discussions. The earlier survey research on work life balance confirms maternity / paternity leave and sabbatical/extended leave are the two most important benefits for female employees. Moreover, Cummings and Worley (2015) note that, “Organizations must design human resource systems that account for these differences if they are to attract and retain a productive workforce and if they want to turn diversity into a competitive advantage” (pp. 497-498).
During the discussion with Dr Palmer, senior staff displayed poor attitudes to workplace diversity. As role models in the organization, senior staff were not displaying leadership behaviors. This has potential to ripple down to other staff and can create toxic environment resulting in employee dissatisfaction and high turnover, and workplace stressors like that experienced by Chris if not addressed. To say the senior staff are not living the organization's values and beliefs would assume there are shared values in the beginning. While Pat and the VP Finance's attitudes towards workplace diversity were poor, Francis' effort to provide her own EAP shows the inconsistency in attitudes and behaviors in the organization culture.
On the topic of change, Janoff (2006) views the group as a system, which “means creating structures within which people could do their best work. Change the conditions under which people interact, rather than try to change the people” (p. 47). This is most relevant when considering the group design issues inherent in the legal department and lab, which are presenting workplace stressors. Using workplace OD interventions to change the organizational conditions that are causing the stress and providing coping mechanisms for those suffering stress will be important. Workplace OD interventions may include a focus on the health facilities available for staff and their families such as intergenerational day care, supportive relationships, role clarification, work scheduling and employee assistance programs (Gibson et al., 1994 cited in Cummings & Worley, 2015, p. 508).
In addition to the focus on organization culture and values for all staff, there needs to be training for management to ensure they are adequately prepared to help subordinates cope with stress. They need to be able to identify stressors and consequences and know what interventions are available to provide assistance to staff. One more area that would need to be reviewed is the HR function, to ensure the team has the right skillset and leadership to facilitate a change of this nature within the organization.
A technique such as Future Search could be used to bring representation from all areas (cross-section of functions) to discuss the outcomes of the research phases already discussed, rather than have one taskforce delivering a top down solution, which will impact such personal aspects of employee's lives. People are likely to be more resistant to change when they have not participated in the process. Through the Future Search three-day sessions, the OD consultant can provide the space for discussion on what HealthCo means to its employees, how they view the past, present and future for HealthCo, and focus on its values and talent. The session may involve discussion on how the company can become a ‘Best place to work' business, what would need to change within the organization and how teams can resolve those issues together.
Using a human process intervention like a future search conference may help in creating the positive energy and optimism around the future that HealthCo needs if they are to create a change in culture and implement work-life program and policies. This type of intervention provides the space to work on the strategy and discuss HR interventions such as reward systems, employee stress and wellness, managing workforce diversity and whether a strategic change intervention is needed for broader cultural change.
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