In order to develop the action plan necessary to develop processes which would mitigate

the problems at the General Surgery Unit, the Five-Step Management by Objectives Process
(Appendix 1) will be used. This approach is of more relevance, especially because, according to
Rodgers and Hunter (1991), it yields positive results and bigger productivity gains when the top
management is highly committed to implementing it, which is the case for Barbara Norris. The
nurse manager of the General Surgery Unit possesses the necessary characteristics which would
prove that she would be potentially committed to leading a change inside GSU and has the
necessary qualifications for it. First of all, Barbara has pursued Masters Program in Nursing and
Health Care Administration, meaning that she has been familiarized with management and
administration basics, approach and mindset. Besides studies, Barbara has shown commitment
and passion to her job, having also an experienced mentor, and took the challenge of becoming a
nurse manager despite the great challenges imposed. Given this, it could be assumed that Barbara
is eager to lead change in GSU, being interested in the best possible outcome. As to develop the
processes, it is necessary firstly to understand the problem the GSU is facing, which would be
the first step in establishing the organizational objectives. As it was described in the case, there
are several problems to be addressed, including shortage of staff, high stress level, low employee
morale, a toxic culture (confrontations, blaming, favouritism), all of them in a general context of
downward turn of economy, best described as a period of cost cutting. From the off-site
discussion it can be deduced that the roots of the problems rely on lack of communication, lack
of a performance management and task assignment system, and the lack of regular trainings and
development processes. All of the above-mentioned problems lead to an inefficient care for the
patients, resulting in declining patient satisfaction scores. Taking into consideration the attempts
of the hospital to cut costs and keep their operations, it can be concluded that the satisfaction of
the patient is a crucial parameter in the operating efficiency of the hospital, the patients being the
stakeholders ensuring the revenue stream for EMU. Thus, the general organizational objective
would be increasing the turnover of the EMU, by increasing the general satisfaction of the
patients and making the hospital a place they trust and wish to address to in case of an
emergency. At this stage, it is of a high importance to keep the organization objectives reachable,
and the means of doing it is focusing on the most important aspects, which is why, in the context
of this work, only one organizational objective will be addressed.

Cascade Objectives to Employees

 Cascading objectives to the employees, in the given context, would, in some cases,
translating the objective into specific tasks which would ensure its fulfilment. However, given
the context, I tend to think that this is not the case. The problem is not about right tasks at GSU,
more exactly, not only about the tasks. Since the employees are dealing directly with patients and
have to provide the necessary care, cascading objectives would rather mean creating an
environment in which the employees would feel comfortable and, thus, would become more
productive and efficient, and only after that, demanding completion of specific tasks. According
to Preston (2017), employees are becoming more productive when they are happy at their
workplace, which is not the case for GSU. Moreover, Spreitzer et al. (2012) suggest that
employees should be thriving, or, as it is depicted in their work, “be engaged in creating the
future”, and the means of making employees thriving at work are: providing decision-making
discretion, share information, minimize incivility, and offer performance feedback. The first
suggestion, providing decision-making discretion, is already in the process of being adopted, as,
at the off-site meeting Barbara tried to involve the nurses in decision regarding staffing.
Moreover, nurses and patient care assistants could be involved furtherly in other decision-
making processes related to their area of work. Sharing information is another step to be made.
In this case, Barbara can combine the decision making and sharing information, by having
regular meetings with the staff, updating them on the situation in the hospital, potential problem,
and seeking together for a solution. As hospitals don’t usually have too much spare time, such
meetings could be organized within shifts, with a regularity of 3-4 weeks, and a duration of
maximum 1 hour. Additionally, one of the problems mentioned above finds its roots in the lack
of communication, thus, these meetings would also have the role of discussion panels, where
employees could express their feelings, and work together towards solving their common
problems. Minimizing incivility would be hard to ensure via a regular approach of not-hiring
people showing uncivil behaviour, as the staff is already established and there are no new
employments to be made. In such a case, the problem related to incivility would be the
interpersonal conflicts, which, according to the case, arise mainly because the nurses are stressed
with the overwhelming number of tasks there are assigned and the lack of expertise and
experience of the relatively-young staff. The solution would rely in adopting a task management
system, which would allow to monitor the number of tasks and the progress through them.
Additionally, a mentorship program can be enacted, with rewards for the nurses showing desire
to mentor less-experienced employees. With the help of the same program, the employees may
also benefit from trainings from more experienced employees, such as Jennifer Goodwin, which
is constantly learning new things. The trainings could be done with bigger periods than the
consulting meetings, meaning that they could take place once in 3 months. In order to ensure that
mentoring nurses get appraised, a KPI system has to be put in place as well. The KPI system will
set the foundation for a performance management system which would appraise the hard-
working nurses, a problem depicted by Jennifer Goodwin in the case, and will help in offering
performance feedback to the employees.

Monitor and Evaluate Performance

The monitoring and performance evaluating processes are to be done via the Key
Performance Indicators system, of a tremendous importance being setting the right indicators and
objectives for the employees and the ongoing problems. As the organizational objective relies in
increasing customer satisfaction, this would be the Key Result Area (KRA), with the respective
KPI being the score given by a customer to a specific employee. To ensure a bigger dispersion of
points and a larger possibility to differentiate, the scale can be set from 0 to 100 points (100
corresponding to fully satisfied). A second KRA would be the training and development, which
would be evaluated by the number of training hours per employee/year (in order to set the target
more details regarding the operation of GSU have to be provided), and the amount of mentoring
time. A problem could arise with the second KPI, as it would be hard to monitor the amount of
time spent by a nurse mentoring another employee, but a solution would be gathering feedback
from mentee and checking both the quality and time. Taking into consideration the KPIs,
Barbara would be able to provide direct performance feedback at short, quarterly meetings, thus,
ensuring that each employee knows exactly what it does best and what it doesn’t.

Reward Performance

As the hospital is facing hard times, it would be hard to ensure the top-performing
employees with top-level bonuses. A solution would be to try and negotiate with the hospital the
bonuses, or implement non-financial-based rewards, such as “Employee of The Month”. The
problem in the second case would be the already existing interpersonal conflicts, which now
could escalade more frequently. However, as it is mentioned that the salaries are still increasing,
adopting a rate of increase based on the performance would be the solution.
References:

Rodgers, R., & Hunter, J. E. (1991). Impact of management by objectives on organizational

productivity. Journal of Applied Psychology, 76(2), 322–336. doi:10.1037/0021-9010.76.2.322

Spreitzer, Gretchen, Porath, Christine. (2012). Creating sustainable performance. Harvard

Business Review, 90 (1), 92-99. Retrieved from http://gr8synergy.com/nimpathways/wp-
content/uploads/2016/04/Creating-Sustainable-Performance.pdf

Preston, Camille (2017, December 13). Promoting Employee Happiness Benefits Everyone.
Forbes. Retrieved from
https://www.forbes.com/sites/forbescoachescouncil/2017/12/13/promoting-employee-happiness-
benefits-everyone/#466ecbab581a

Appendixes:

Appendix 1: The Five-Step Management by Objectives Process