Montefiore Medical Center Essay

1- Why does Elaine Brennan need to develop a new strategy now? A great manager will be the one who is able to examine the environment, determine opportunities and threats, plan accordingly, implement the plans and evaluate the results of his planning on frequent basis to add more value to what his/her organization is built to accomplish. Elaine Brennan needs to develop a new strategy now because according to the Systems Look at Healthcare, a merger has happened between two facilities each of which provide a different level of care. Each of these facilities was 4 miles away from each other, and both of these facilities’ staff members were operating in silos. Since Montefiore agreed to operate Einstein’s patient-care facility back in 1963, its scope of coverage increased to about 1.2 million residents, 65% of which are minority populations. Montefiore had 16+ competitors in the Bronx area, a condition that led to lower scores at the national level, together with lower compensation levels for employees, unsatisfied patients, amounting to a budget deficit of about $57 million dollars in 1995. Even with the consolidation of the two health care facilities, still there are certain disadvantages that need to be taken care of. There will be fewer workforces to provide for the desired level of care after downsizing. With that on hand, more responsibilities will be granted at the expense of enjoying the usual authority level granted to staff. One final challenge that will add to the necessity of formulating a new strategy for Montefiore medical center is related to the concept of organizational change and the leadership styles needed to support that organizational change. Level| Target Parameter| Pressing Matters (Needs)| D: Environment.| 1- Competition.2- Regulations.3- Demographics.4- Payer Policies.| 1- 16+ other hospitals in the Bronx area.2- Difficult reimbursement potential from payers.| C: Infrastructure.| 1- Infrastructure.2- Leadership.| 1- Separate administrative teams.2- leadership teams adaptation to change.| B: Microsystems.| 1- Teams.2- Tools.3- Logic.| 1- Downsizing.2- More stress and turnover.3- more span of control with less authority.4- Decreased quality.5- Cultural consolidation.| A: Patient.| 1- Coverage.| 1- Provision of services to 1.2 million residents.2- 65% minorities (Hispanics and African Americans).| 2- Does the GRIP strategy meet the needs of this organization? According to the Systems Thinking, Montefiore’s corporate strategy should be most influenced by the four key environmental factors (competition, governmental regulations, demographics, and payer policies), yet the current GRIP business strategy which was formulated by Brennan, is supposed to be specifically addressing the Acute Care Division as a business unit, not the entire organization. On the other hand, the case doesn’t indicate which levels of management participated in the meetings Brennan conducted for planning the new strategy for the Acute Care Division. Moreover, and as we go down the organizational hierarchy, strategic goals should be more constrained by corporate level strategies, more detailed with shorter life spans according to the plans provided, and finally, more action-oriented with more specific goals. Given all of the above, I think that what Brennan managed to create was a GRIP strategy that was tailored for the whole Montefiore organization. As regards whether it met the needs of Montefiore, I think it broadly addressed some unmet environmental needs that are provided in the following table: Also, the Systems Thinking model tells us that no system is ever completely stable. Per se, the GRIP strategy is beneficial but it will not guarantee the stability of the Montefiore medical center. There is no clear space for metrics that will measure success of the operations after implementing such strategies. Also there is expected delay in the performance of the organization if metrics were not identified to measure performance at the national level. If the Balance Scorecard (BSC) section was included as a way to implement the new strategy, then I would say that the new strategy will meet the needs of the organization. 3- Why was implementing the scorecard concept by the medical staff difficult? a- The scorecard concept requires data collection because these data will later on be reported to different levels of managers. Only then that managers will be able to judge if their goals are being met or not and then act accordingly. The data collection part of performance improvement is the most tedious and time consuming task in process improvement projects. b- In order to keep the patient flow within the Montefiore medical center, some subspecialties had to be accommodated by all hospital departments in order for revenues to keep coming out for the whole health care facility, except for that due to that each unit had its own revenues and expenses, which made it hard to create a new system for monitoring patients between departments and services in order to build revenues according to overall expenses. c- It was hard to involve some physicians into the suggested scorecard process maps. Physicians usually think that what they ordinarily do is best for the patient, especially when it leads to treatment or cure from disease or condition. They can’t embrace doing something different that is addressing unusual metrics from the ones they are used to use. They also look at learning about improvement as a first step towards undermining their authority and ego. d- From a human resource point of view, Lewin’s model of organizational change, and Kubler-Ross model for overcoming organizational resistance to change, take time to get results out of them. Kubler-Ross model for overcoming organizational resistance Source: www.movida.net78.net 4- What could Brennan have done better? a- Brennan could have done better to involve physicians into project teams in a more consistent and solid way. When physicians are involved in the value mapping process, they can provide valuable inputs to data gatherers, which – on the long run – can save a lot of data gathering time for the regular evaluation process. It also will increase the project team’s cohesiveness and collaboration towards attaining their goals. Otherwise, the deployment of the scorecard system into the newly designed health care centers will be much more difficult and time consuming which is not good in the face of the great competition lying ahead. b- Brennan also could have done better to spend more time on studying how the different staff members of the different care and support centers will respond to the new responsibilities in shaping improvement tools for Montefiore medical center, and then try to create feedback circuits that will both reward over-achievers and highlight reluct ant or incompetent workers. c- I think that Brennan should have done better to recommend that every department use only national-level strategies and not both national and local-level ones. Individual metrics tend to be too easy to accomplish, and its fulfillment may lead to a false belief of accomplishment, which is not good in the face of sustaining a competitive advantage. d- I don’t think that linking compensation to performance will be an obstacle in front of reducing budget deficits for the new system. I think that due to organizational change, there will be downsizing at all organizational levels, and may be some middle level active managers and medical staff will be promoted to high level or more operational-involved positions at a relatively lower salary. The bottom line is that there will be deficit reduction but at a much slower pace, together with a re-inforcing feedback for performance. e- I also think that Brennan has taken implementation of the GRIP strategy a little bit too fast. She might be tempted by the quick $15 million cost savings that she accomplished from downsizing on some managerial positions in 1996, but it is still a fact that if she wanted more solid environmental stability during the implementation of the new strategy, she has to allow time for unfreezing, moving, and freezing stages of the Lewin’s model of change.