HR7240: Green Hills Hospital Leadership and Change Management Report

This report presents a case study analysis of Green Hills Hospital (GHH), focusing on its leadership, human resource management (HRM), and organizational culture. The report examines GHH's establishment, value proposition, and operational challenges, particularly concerning patient experiences and internal inefficiencies. The analysis delves into internal and external factors driving the need for change, including issues with administrative processes, communication barriers, and unethical practices by some medical professionals. The report further explores how leadership changes could positively impact GHH, emphasizing the importance of creating urgency for change, developing a powerful coalition, introducing a clear vision, and implementing effective communication strategies. The case highlights the need for improved teamwork, ethical conduct, and streamlined processes to enhance patient satisfaction and operational efficiency within the hospital setting. The report concludes with recommendations for leadership and change management strategies to address the identified challenges and improve the overall performance of Green Hills Hospital.

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GREEN HILLS HOSPITAL
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GHH was established towards the end of the 1960s and initially had 450 beds for the in-
patient. GHH only specialized in surgeries that were categorized as high-risk that utilized the
latest technology in the medical field (Kayalar, 2012). The hospital had gone further to receive
several accreditations from multiple global health care accreditors and won many local
management awards in the category of human resource development and excellence in its
management. Green Hills Hospital was an affiliate of the Health-Sa group which was categorized
as a large health care group situated in Puraasia and ran more than 19 hospitals with more than
5000 hospital beds for the in-patients across Asia (Kayalar, 2012). It also recruited a team
composed of more than 1500 health specialists that had received accreditation for more than 50
medical specialities.
Experience of HRM, leadership and culture at GHH
The Green Hill Hospital had a value proposition that was simple to observe and
understand. Green Hills Hospital has developed synergies by identifying and sourcing the best
doctors in Puraasia at GHH that were based in a separate annex (Kayalar, 2012). This enabled
investment in state-of-the-art technology with regards to the modern diagnostic equipment as
well as in the laboratory facilities. GHH also ensured investments in establishing a well-
functioning operating facility. GHH business model was highly successful, and many patients in
need of quality health care had to travel to GHH travelling from all regions of Asia with the
inclusion of the Middle East.
However, irrespective of such positive attributes, the appointments by a doctor in
Puraasia seemed to be working to a certain extent. In comparison to most regions of Western
Europe and North America where appointments were strictly followed to the latter and serious,
in Puraasia a 9 a.m. appointment could be made to work at 11 a.m. (Kayalar, 2012). The waiting

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chambers were full to the brim, and it became a full-time job that consumed most of the time in
seeing a doctor. Time as for Lee was valuable, and his perception of a GHH system may be due
to his cultural paradigms that stipulated how precious time was.
The procedure was scheduled at 7.00 am which turned out that the cancer diagnosis for
Lee’s wife was a false positive (Kayalar, 2012). According to Lee, the procedure began as
planned with no delays and Lee was called to the operating room immediately his wife gained
her conscious. Lee even hailed the post-operational care as it was of a high standard. The nursing
staff at that time were productive and responded to matters immediately, and Lee could see their
sympathy if not empathy right from the nursing staff who took good care of Mrs Lee. Dr. Sun
made his routine to check Mrs Lee each morning a and evening and even ensured that everything
was administered in the right manner (Kayalar, 2012). Room service was in the offer list by
GHH with a mini-bar identical to what a hotel could provide. According to Lee, everything at
GHH was efficient, and all the apparatus were well-functioning.
Internal forces driving need for change
The checking out process was slow as Lee had to follow up to complete the paperwork.
However, despite the sluggishness, Lee was happy particularly with the good results of the
diagnosis (Kayalar, 2012). Lee realized some anomalies with his account as multiple unrelated
charges as well as overly expensive items that could not be accounted for had been added to his
wife’s account. The insurance company would decline to pay for such additional expenses.
It was unfortunate that Lee’s wife treatment was not over as she was referred to another
specialist in the same GHH who would take her through the remaining process of her treatment
since chances of cancer in other organs remained a threat. In the next couple of months, Lee had

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to travel to Puraasia many times ranging from three to four days in a bid to continue with the
treatment.
The new doctor to continue with the treatment was Dr. Lung. However, despite Dr
Lung’s knowledge and profound experience in the medical field, he seemed unfamiliar with the
doctoring and administrative procedures (Kayalar, 2012). For instance, he had the habit of
scheduling appointment s in the morning yet she would arrive late creating a large backlog of
disappointed patients. In spite of practising her medicine at GHH and having access to laboratory
facilities at GHH, Dr Lung referred every diagnostic test to a clinic outside the premises of GHH.
Such a behaviour can be attributed to a lack of trust in the quality of diagnostics at GHH or was
for commercial purposes. However, it is evident that the healthcare industry in a region such as
Puraasia is highly commercialized at the expense of human life.
The GHH clinic also seems to grapple with the challenge of being unfamiliar with some
health insurers as evidenced in Lee’s case (Kayalar, 2012). There were bureaucratic legalities
that had been to be followed to ensure that they certify coverage and had to speak with many
clinic administrators and make international calls to ensure that they get admission. There was a
communication problem, and the language barrier cropped up sometimes. A test that could run
for less than 15 minutes could take more than 2 hours to get administered (Kayalar, 2012). In
another scenario, a cancer marker test that was late led to the clinic proposing for an extra fee if
the Lee’s wanted the results to be rushed ahead of their scheduled departure. This is
unprofessional and unethical at the same time based on the fact that the test was simple and the
clinic ensured that it processed the test slowly. The other explanation for such a practice was that
the delay was done deliberately as anxious patients who were eager to get the results if they had
cancer were more ready to part with the extra fee to learn the results.

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External factors impacting on need for change
Dr Lung opted for a chemical treatment that was to be followed by a surgical procedure.
However, getting the required medicine almost became impossible (Kayalar, 2012). The
expected stock from Dr Lung’s stock had finished and based on a phone call to a supplier the
delivery could take two to three days to be delivered, and this was after Lees’ departure, or the
other option was to deliver bulk order of 20 units. Sourcing the medicine and using the services
of a new doctor to administer the drug in the Philippines would be much of a hardship. The Lees
had to make an inquiry about whether the drug was available at GHH pharmacy though nobody
had raised the possibility of GHH pharmacy (Kayalar, 2012). This seemed to be a barrier
imposed by the Chinese between GHH and Dr Lung’s clinic. Disputedly, the three doses of
medicine had to be sourced from GHH pharmacy following the long wait.
The doctors at GHH prescribed and sold medicines at their discretion; thus, medications
were not readily available in their stocks, and they would involve the GHH pharmacy and later
invoice the patients (Kayalar, 2012). A considerable amount of markup seems evident even when
the doctors bought the medicine was sourced from GHH pharmacy as patients were discouraged
not to purchase medicine directly from GHH pharmacy. The doctors considered purchasing
medication directly from manufacturers and selling them to patients as a lucrative business.
Following competition of the chemical treatment, Lee’s wife was ready for the laparoscopic
operation. Once again, Dr Lung had proposed that several pre-operational diagnostic trials be
done and this was to be performed in an external clinic that Lees had been referred (Kayalar,
2012). The scheduled operation had made Lee’s wife tired, and Lee had requested that the tests
be done in-house at GHH. Following the doctor’s consultations with the administrative
assistants, the sidelined and even delayed the whole process.

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There was a replacement of the administrative staff with new and inexperienced staff
who were reported to be experiencing difficulties with operating the IT system (Kayalar, 2012).
It was unfortunate that the supervisors had to observe rather than attending to such matters
personally and help in making up for the low count of employees (Kayalar, 2012). It was after a
long wait that the check-in procedure went through successfully as Lee’s wife schedule was to be
done at 3.00 pm the following day while the hospital check-in was done at 11.00 a.m. It was the
next morning that they arrived at the hospital at 10.45 a.m. only to be informed that the room
was not ready and was advised to get back at noon (Kayalar, 2012). The attitude of some of the
staff that had served them earlier seemed cold and uncaring, yet they were responsive to their
supervisors. They checked in around 1.45 p.m. that is when the room was ready, and this was
possible with the aid of a kind concierge who opened up it was his first day and attempted to
solicit a tip.
How change in leadership could impact positively on GHH
The process of ushering change requires the entire company to embrace change and work
towards initiating it (Mind Tools, 2019). Developing the need for a necessity around the desire
for change is prerequisite for change. This may imperative in sparking the starting motivation to
get things started. The first thing to start with is identifying the threats, for instance, GHH has
several potential risks such as changing of administrative staff personnel and nurses who take
time to acquaint themselves with the operation and culture of the hospital
Kotler 8 step change model
Create urgency
. The change of influential people such as the chief executive officer makes the ways
things run in the hospital change. Such changes could affect patients as little is done to ensure

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efficiency. There are bureaucratic procedures before things get right. This could make patients
seek other better alternatives such as turning to public hospitals.
Many opportunities could be exploited; for instance, GHH had a reputable image and
name which they could use to improve patient experience through courteous relationships. Also,
they could equip their laboratories to meet the state-of-the-art facilities in the regions.
Developing a powerful coalition
It is crucial for the management to convince its staff that change is needed. This will
command robust leadership and real support from influential individuals in the organization
(Juneja, 2015). Change management is not substantial, but it has to be led. In the case of GHH,
the doctors, the administrative staff and the nurses are the change agents needed. The doctors
have to understand that treating patients is nobler compared to soliciting money through
unprofessional and unethical means. The nurses also need to learn that patients need them and
soliciting tips is not the best way to serve. A powerful union between the administrative staff,
doctors and nurses in a bid to serve humanity at GHH would be crucial in ensuring a positive and
lasting change needed. Such players need to have a passionate dedication knowing that they
swore an oath to serve people and that service comes first. There is also a need for teamwork
between the doctors and the administrative staff as evidenced in GHH where Dr Lung and the
Chinese seemed not to be working in tandem, and this ended up affecting the Lees. Teamwork is
crucial as it eliminates misunderstanding.
Introducing a vision for change
The idea of change brings on board many ideas and solutions. Such concepts, when
linked to the overall vision, enable people to understand and remember easily (Mind Tools,

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2019). It is through a clear vision that people understand why they are doing particular things.
Thus, it is imperative to identify values that are core to the change.
Regarding GHH, time consciousness is one value that should be revised accordingly. The
appointment by the doctors needs to be punctual to save people the pain of waiting to be
attended. GHH’s management should develop a strategy required to effectuate the vision, in this
case, there should be attendance sheets that show when a particular patient was accorded
appointment, and such sheets should be checked regularly, and the doctors that are late should be
summoned and be given warnings.
Communicate vision
After the formulation of a vision, what gets done after determines the success of the
company with regards to that vision. There is a need to communicate the vision frequently and
embedded in everything being done (Juneja, 2015). GHH’s vision to be the leading health
provider in the regions should not only be expressed in meetings chaired by the management but
should be emphasized in day to day operations of the hospital.
Remove obstacles
Following these steps ensures that the organization reaches this point in the change
procedure with regards to realizing the vision and ensuring that all levels in the organization
work in unison to achieve the desired change (Juneja, 2015). However, effectuating change is a
path faced with much resistance due to the foregone opportunities and emerging conflict of
interest. At GHH, the new nurses recruited are having difficulties with communication; the
management should hire people who have a good command of the language. Also, based on a
conversation with one of the nurses, it was evident that the recruits were to serve for a short-term

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and head back to their countries. The management should fix this by employing permanent
nurses who can render their services for a long time and get along with patients.
Create wins that are easily achieved
Success is a great motivation. For change to be realized, it is imperative for an
organization to allow the taste of victory during the initial stages of the change process (Mind
Tools, 2019). This could be within either a month ensuring that the staff can see such immediate
wins. For instance, the case of GHH it is evident that both doctors and nurses use unaccepted
means to boost their income (Kotter, 2017). Instead, the management can introduce bonus
schemes to reward those performing best. Also, the doctors and nurses who work overtime could
be compensated for their services by being paid for every hour they work overtime, and this
could motivate them to be efficient and work better.
Build on the change
Kotter postulates that a majority of change projects never see the light of the day as
victory gets realized too early. However, real change is, and the quick wins are just a start of
what has to be done to attain the long-term change (Juneja, 2015).GHH should begin by
analyzing what went right following success and what has to be improved. For instance, the
management should figure out why the services were efficient at first and why there is laxity
among the nurses. It is also crucial that the administration bring in new change agents and
influencer to usher in the needed change.
The changes should be incorporated in the corporate culture
The initiated change should be made part of the organization. The corporate culture
dictates what has to be done, the values embedded in the vision should be seen in day-to-day
operations (Webster & Webster, 2019). For instance, the supervisor should find it in their hearts

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to help the new employees in understanding how the new system work to avoid delays on the
side of patients. The management should also have plans that replace vital leaders to ensure that
change flows in GHH. This will be crucial in ensuring that GHH’s legacy is not lost.
Leadership styles
Research has revealed that the leadership adopted by management is responsible for 30%
of the profitability realized by a company (Educational Business Articles, 2016). Goleman
unearthed six leadership styles among the managers that he observed as well as the impact they
have on the corporate atmosphere.
The pacesetting leader anticipates and models achievement and self-direction. The
pacesetting style is effective when the team is motivated and skilled, and the leaders in need of
quick results (Benincasa, 2012). In the case of GHH, this form of leadership will work although
both the nurses and doctors are demotivated yet skilled. The hospital needs a leader who will
bring things back to sanity; for instance, issues of delay should be eliminated.
The authoritative leader directs the team toward a shared vision and concentrates on end
goals (Gazzara, 2017). This style works best when the team needs a new vision following a
change in circumstances, and this is what GHH needs since there are new nurses and the chief
executive officer is also new. An authoritative leader in the case of GHH would inspire an
entrepreneurial culture and great enthusiasm needed for the mission.
The affiliative leader develops an emotional attachment that evokes the feeling of
belonging to an organization (Casali, 2015). GHH needs this kind of leader to bring back the lost
trust in the hospital facilities as there is no need for patients to be referred to external clinics.
The coaching leader trains people for the future. This works well when the leader seeks to
help teammates establish lasting individual strengths to make them more successful. The new

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CEO has a background of medicine he could coach the doctors and nurses on what could make
the hospital successful in dealing with patients.
The coercive leader commands urgent compliance and works best during a crisis (Casali,
2015). This kind of leadership is not ideal for GHH as it could alienate the bond between
management and the staff.
A democratic leader develops consensus by allowing participation and is useful when a
team is required to have to say in a decision or a plan (Benincasa, 2012). GHH also needs this
kind of leadership to understand what the doctors and nurses need to work and deliver the
desired results.
Goleman’s emotional competencies
Self-awareness refers to understanding how emotions impact on performance (Goleman,
2015). The nurses at GHH need self-awareness as declining to give them a tip that makes them
angry, and they refuse to assist a patient.
Empathy refers to understanding the feelings of other people and taking an active role to
know how they feel and think (Goleman, 2015). GHH nurses and doctors need empathy as they
fail to understand the pain of their patients as seen in Lee’s wife when a nurse threw a chart on
the operated part.
Self-management
Self-control with regards to emotions enables people to suppress disruptive emotions and
maintain effectiveness in stressful environments (Key Step Media, 2017). A good number of
nurses at GHH need to learn this for them to deal with patients ethically as most lack self-
management.

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References
Benincasa, R., 2012. 6 Leadership Styles And When You Should Use Them. [Online]
Available at: https://www.fastcompany.com/1838481/6-leadership-styles-and-when-you-should-
use-them
[Accessed 15 April 2019].
Casali, D. F., 2015. The Six Styles of Leadership. [Online]
Available at: https://intenseminimalism.com/2015/the-six-styles-of-leadership/
[Accessed 15 April 2019].
Educational Business Articles, 2016. The Six Leadership Styles for effective Team Performance.
[Online]
Available at: https://www.educational-business-articles.com/six-leadership-styles/
[Accessed 15 April 2019].

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Gazzara, K., 2017. 6 Leadership Styles & Which One You Should Use. [Online]
Available at: https://medium.com/@doctorkevin/https-medium-com-doctorkevin-6-leadership-
styles-aed48d85537f
[Accessed 15 April 2019].
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[Accessed 15 April 2019].
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Available at: https://www.managementstudyguide.com/kotters-8-step-model-of-change.htm
[Accessed 15 April 2019].
Kayalar, J., 2012. Green Hill Hospital:Leading Change Management. [Online]
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[Accessed 15 April 2019].
Key Step Media, 2017. Emotional and Social Intelligence Leadership Competencies: An
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Kotter, 2017. 8-STEP PROCESS. [Online]
Available at: https://www.kotterinc.com/8-steps-process-for-leading-change/
[Accessed 15 April 2019].

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Mind Tools, 2019. Kotter's 8-Step Change Model. [Online]
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[Accessed 15 April 2019].
Webster, V. & Webster, M., 2019. Successful Change Management — Kotter’s 8-Step Change
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