Leading Change in EMU's General Surgery Unit: A Case Study

This case study examines the challenges faced by Barbara Norris, a nurse manager at Eastern Massachusetts University's (EMU) General Surgery Unit (GSU), including high employee turnover, declining patient satisfaction, and a negative work culture characterized by favoritism and poor performanc...Read More

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Leading and management

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Contents
Introduction.................................................................................................................................................2
Problems......................................................................................................................................................2
Recommendations.......................................................................................................................................4
Conclusion...................................................................................................................................................6
Reference.....................................................................................................................................................7

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Introduction
This report includes the case study analysis and description of the situation is outlined. The
company faced various problems that are identified which are required to be considered for
solving the issues. The entire organization is affected because of the behavior of the staff. The
case includes the problems or challenges which are faced by Eastern Massachusetts University
(EMU) in the Department of General Surgery Unit. It is analyzed in the case that Barbara Norris
works as a nurse manager in the GSU department and she is well respected and the best nurse in
EMU. She always considers all her responsibilities and works effectively by providing the care
and services to patients in the GSU department. She is required to consider the issues or
problems which are faced by the staff nurses in the department and expected to resolve the issue
for improving the performance. The recommendation will be provided for improving and solving
the issues at the end of the report.
Problems
In the GSU department, Barbara Norris is a manager which requires to manage the staff and
budget of the entire department. The staff in the GSU department includes the 33 includes 25
RNs and 8 patients care assistants. In the department of GSU, it was difficult in the first month as
two RNs and after six months of joining another three RNs left. Also, the hiring was freeze in the
EMU which was challenging to have a shortage of nurses in the unit. It is analyzed that because
of a shortage of nurses, Barbara faces the issues of not filling the vacant position of RNs. With
the shortage of nurses, the present nurses faced the issue of stress as high because of more
workload (Marr, 2012). It is also analyzed by Barbara that the proper record of employees'
annual performance reviews is not recorded of the staff for analyzing the bonuses and
increments.
The department is also facing the issue of a high employee turnover rate. It is reviewed that the
nurses are required to take care of the patients and provide effective services to them. The
satisfaction report of patients was also average and declining from the last few years. In EHU,
the external stakeholders were impacted because of the major problems in the operations as the
satisfaction level was declining day by day (Nelson-Brantley and Ford, 2017). Another issue in

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the GSU department is of conformation culture, which includes blaming and favoritism. It is
analysed that the department is required to renowned the culture in which the favouritism
element is considered as quite evident and nurses feel that they are been deprived of being
motivated by the management level (Roumboutsos, et al., 2013).
In the GSU department, tensions exist between caregivers and with many departments of the
attending physician. In addition, to make this situation worse, nurses are not provided with
overtime hours because they do not want to pay for additional cost-cutting measures. Cost-
cutting in the department is done and over-time is not offered to nurse which does not allow
them to work extra as they require to be paid extra for the extra work. Norris is facing this issue
as if one nurse fall sick or go on vacation, she was not able to provide the overtime to the staff
for covering the absences and she was forced to rely on RNs from the general float pool and they
were not familiar with the work, process, care, and procedures. It leads to creating the negative
effect of the staff on the quality of patient care (Lavu, et al., 2010).
It is analyzed that the nurses are the stakeholders of the GSU and they are affected because of the
work pressure and stress during the work. Also, they were not getting their actual performance
reviews according to their work and performance and along with that, they were required to deal
with the issue of high-cost cutting. In EMU, the other stakeholders were not getting the return on
their investment and dissatisfaction was making them stay away from the GSU of EMU (Jones
and Harris, 2014).
In order to understand the situation and issues, Norris asked the staff to write the issues which
the staff is facing during the work. It is analyzed that the Norris is required to understand that
open communication is important and transparent review system is required for the growth and
development of the team (Abujudeh, et al., 2010). According to the case, Norris is required to
improve the communication within a team for which she planned for Off-site for the GSU staff.
Off-site helps in analyzing the issues which are faced by the staff. Off-site is helpful as she asked
the staff to put their grievances in which three staff came forward as discussed. Norris also tried
to analyze the solution for which she had asked the staff for the solution as she considers that the
involvement of employees helps in resolving the issues soon and the opinion of employees
matters for making the right decisions. Majorly the issue which is faced by the employees in the
GSU is dissatisfaction in the procedure of reviewing the performance of the staff. It is identified

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by Barbara that in the unit every staff gets the same regardless of their performance and this is
happening because of a mystery of performance review system which is not used for reviewing
the performance and rewarding staff according to their performance (Gupta, et al., 2018). It is
essential for the satisfaction of staff to review their performance and provide the benefits as per
their performance and capabilities. Louise who is working with EMU for the last 30 years is also
facing the issue of younger nurses and face difficulty in making a various decisions and taking
care of the patients. By Barbara, all the issues were analyzed and identifies includes the culture
which does not value teamwork and collaboration. Favoritism and relationship-based
assignments are more.
Recommendations
It has been analyzed that various issues are faced by staff in EMU which is required to be
resolved. The possible solutions and alternatives are required for the issues which are faced in
the general surgery unit includes-
KPI- Reducing the employee turnover rate
In the case study, it is analyzed that GSU is facing the issue of high turnover and the low
retention of employees. GSU is facing the severe problem in which Norris is required to
determine the suitable replacement for the nurses who left the GSU. It is founded that cost-
cutting is the major problem that requires to measure of restricting for hiring the new nurses
(Groysberg, et al., 2019). For achieving this KPI, it is recommended to Norris to hire the new
employees within the GSU.
It has been analyzed that new nurses are hired; they will be able to find more employees who can
work for other employees. At the same time, GSU was equipped with new nurses, thereby
reducing the pressure on the unit (Day and Shannon, 2015). Reduced stress levels will keep
nurses longer because they do not find any stress. Therefore, it helps in reducing the rate of
turnover. Along with this GSU, nurses can take the leaves for personal purpose or sick leave as
the replacement of them is available.
KPI- Meetings and sessions

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In order to make the effective relationship between teams and with the manager, as it is analyzed
that in GSU the staff is quite silent and reserved and does not take part in interacting with each
other and also does not provide the support to other staff. The communication issue is affecting
the patient's care and it is decreasing the level of satisfaction. In order to attain this KPI, it is
recommended to Barbara that to conduct the meetings for interacting with the staff and
increasing the communication and interaction between the nurses (Sachez and Robert, 2010). It
helps in making the communication effecting and motivating them to support each other at the
time of requirement for performing the work. This KPI will help in solving the issue of
communication.
KPI- Improve performance
This KPI is necessary as the different issues are faced by the nurses and it will help in improving
patient retention. It is analyzed that the retention of the patient is possible when they find the
effective services from the nurses and it is necessary for the patients to get the services on time.
In order to meet this KPI, the nurses are required to improve their performances with the help of
coordination between nurses. Moreover, patient retention is required to be considered by the top
management by reviewing the nurse's performances (Velimirović, et al., 2011). It is
recommended to record the transaction of nurses as it will help in analyzing the performance
which can be upraised. During the process of performance appraisal, EMU senior manager is
required to consider the employee's record for reviewing the performance of the staff. In this
case, KPI will help in solving the issue of performance review and fair review help the
employees in motivating.
KPI - Satisfaction of patients
It is analyzed in the case that the score of patient satisfaction is getting affected because of the
stress level is high of nurses for providing the care and services in the absence of other staff. The
staff is feeling to have a culture of the conformation, blaming and favoritism are affecting the
nurses as they feel demotivation which leads to dissatisfaction of patients. The performance of
the nurses is declining because of the issue which they are facing and it is required to provide the
recommendation for managing the behavior of the nurses. The manager of the nurses is required
to be fair in making the decisions relating to the staff. In order to attain the KPI, it is necessary

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for the manager to manage the nurses and their behavior by dealing and making fair decisions
and offering them a high level of satisfaction. It will help the staff to work in an effective manner
because they will get a positive culture which will help in bringing motivation to work harder
and will be able to provide more safety to patients. It is analyzed that this KPI is necessary which
will help in dealing with the satisfaction of patients which is necessary to be maintained for
EMU for growth and development (Smith, 2011).
Conclusion
In order to conclude the report, Barbara Norris who is the manager is required to deal with issues
that are faced by the staff in the general surgery unit. In GSU, the manager's job is difficult for
the manager and they are required to deal with the different issues and required to provide
effective services for the patients. The issues which are required to deal with include the high
turnover, unfair performance review, favoritism, and many more. Barbara is required to solve the
issue by setting realistic and attainable goals. The activities which are performed for making
decision includes the Off-site activity which is required for understanding the opinions and
issues which are faced by the employees. The various recommendations are provided for dealing
with the issues which will help in making effective decisions and the recommendations are
provided with the help of KPIs which are linked with the issues. KPIs are provided which will
help in contributing to reduce or eliminate the issues which are identified by Barbara during her
job of manager.

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Reference
Abujudeh, H. H., Kaewlai, R., Asfaw, B. A., & Thrall, J. H. (2010). Quality initiatives: key
performance indicators for measuring and improving radiology department
performance. Radiographics, 30(3), 571-580.
Day, G. E., & Shannon, E. (2015). Leading and managing change. Leading and managing health
services: An Australasian Perspective, 295, 405-412.
Groysberg, B., Nohria, N., & Bell, D. (2019). Barbara Norris: Leading change in the general
surgery unit. HBS Case, (409-090).
Gupta, P., Agarwal, A. K., & Sarangapani, S. (2018). U.S. Patent No. 9,998,565. Washington,
DC: U.S. Patent and Trademark Office.
Jones, M., & Harris, A. (2014). Principals leading successful organisational change: Building
social capital through disciplined professional collaboration. Journal of Organizational Change
Management, 27(3), 473-485.
Lavy, S., Garcia, J. A., & Dixit, M. K. (2010). Establishment of KPIs for facility performance
measurement: review of literature. Facilities, 28(9/10), 440-464.
Marr, B. (2012). Key Performance Indicators (KPI): The 75 measures every manager needs to
know. Pearson UK.
Nelson‐Brantley, H. V., & Ford, D. J. (2017). Leading change: a concept analysis. Journal of
advanced nursing, 73(4), 834-846.
Roumboutsos, A., Mladenovic, G., Vajdic, N., Wündsch, B., & Temeljotov-Salaj, A. (2013). Use
of key performance indicators for PPP transport projects to meet stakeholders’ performance
objectives. Built Environment Project and Asset Management.

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Sanchez, H., & Robert, B. (2010). Measuring portfolio strategic performance using key
performance indicators. Project Management Journal, 41(5), 64-73.
Smith, I. (2011). Organisational quality and organisational change: Interconnecting paths to
effectiveness. Library management, 32(1/2), 111-128.
Velimirović, D., Velimirović, M., & Stanković, R. (2011). Role and importance of key
performance indicators measurement. Serbian Journal of Management, 6(1), 63-72.