Creating the Ideal Healthcare Organization: Programs, Policies, Roles and Responsibilities

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golden keyWe compiled a list of the ten key attributes of the ideal healthcare organization.  The first concerned organizational mission, vision, ethics and values. The second was that “employees are treated and compensated fairly and receive great benefits.”

The third of these is as follows:  “Programs, policies, roles and responsibilities are clearly understood, followed and supported.”  This is a common problem area for organizations, but in healthcare it can be literally a matter of life and death.

Healthcare organizations frequently do a lot of things.  For one randomly selected hospital we found a list of fifty-nine different medical services provided; it also had eighteen medical departments and fort-six training programs listed.  Even that of course omits many other functions.  Certainly it is “idealistic” to expect that all hospital employees can understand and promote all of so many endeavors, but the goal should indeed be that every doctor, nurse, administrator, cafeteria worker, janitor, etc. be have such knowledge.

How can organizations inculcate such learning? Obviously training programs are one solution; everyone should be regularly oriented and regularly retrained on what the organization does.  An intranet is another good idea, allowing employees access to organizational information and fostering knowledge management.

But perhaps the best way to achieve understanding is to regularly survey employees on their knowledge and opinions. Offering all employees the opportunity to evaluate, give feedback on, and make suggestions about all organizational functions is a sure way to motive their interest in and awareness of these matters.

The Joint Commission mandates a policies and procedures manual; a randomly selected example lists more headings that we could count.  Clearly, knowledge management is an important in healthcare, and the ideal organization must be a learning and knowledge sharing organization of the highest order.

Though policies and procedures can and should be codified in way that all employees have access to them (an intranet being the obvious means, though requiring constant vigilance regarding issues such as updating, clarity and obfuscation), obviously no one can be familiar with them all.  Yet all employees should be aware of their existence and thoroughly informed about those that apply to them.  Naturally, that raises the question of who has to know what, which leads to the critical question of roles and responsibilities.

It has long been understood that lack of clarity and acceptance of roles and responsibilities can be a crucial factor in healthcare. The professionalism of the various actors and the complexity of the system make conflict in this area all too common. The only effective way to resolve such issues is to have all employees motivated, engaged, and participating in ongoing discussions of what they and others do, how it is all done, and how improvements can be made.

Finally, it is important to realize the programs, policies and procedures are not documents.  “Following the book” is not a way to guarantee to successful outcomes.  Training and learning resources are helpful but not sufficient in themselves.  Instead, the principles and details at stake have to be part of the organizational culture.

To ensure that such standards are understood, followed and supported organizations must engage and give a voice to all employees. Codification, education and discipline all have a place, but unless the leadership listens to all employees and provides them with appropriate forums for their views and ideas rules and regulations will have only “paper reality”.

Policies, program and procedures are everyone’s responsibility.  If you are a CEO, you might actually want to tear up the book and start over again, giving everyone the chance to become involved and enthusiastic.  If you are a manager, you can put particular issues on the agenda for unit meetings.  If you are a doctor, nurse, attendant, lab worker, housekeeping,  maintenance or other staff involved in maintaining a safe, secure, and clean environment. you can make it your business to learn about them, to offer suggestions to make them better, and to start discussion for that purpose.  Even patients may want to study hospital information sources beyond those that they may be handed or see on the walls in the interest of advancing their care, exerting their rights, and fulfilling their responsibilities.

jim murphyJim Murphy has a solo consulting practice called Management 3000, focusing on organizational development and change management. Being semi-retired, Jim is willing to provide very reasonably priced consulting, coaching or  project work for organizations aspiring to improvement in organizational culture, effectiveness and employee engagement.

Formerly he led the Massachusetts Bay Organizational Development Learning Group, was Human Resources Director for the City of Boston Assessing Department, and served as a consultant with the Boston Management Consortium.  His consulting practice includes management coaching as well as research and writing on employee relationships, leadership, healthcare and collaborative practices.  Having produced newsletters for several organizations  and being a frequent content writer for the”Confident Voices in Healthcare” blog, he is interested in writing and research opportunities, as we all consulting and coaching.


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3 Responses to Creating the Ideal Healthcare Organization: Programs, Policies, Roles and Responsibilities

  1. Pingback: Creating the Ideal Healthcare Organization: The Role of Diversity

  2. Pingback: A Third Question for Creating the Ideal Healthcare Organization: Patient Information

  3. Beth_Boynton_RN_MS says:

    This is a great post, Jim and rich with opportunities for discussion. We face so many challenges in HC. The urgency of the work, overlap in roles and responsibilities combined with silo mentalities and organizational structures, limited time and other resources, high stakes high stress work all of which make it difficult to ensure that everyone understands and follows programs, policies and protocols. This raises the question; are they supported? I think we have to have to be creative with resources as well as recognize that there are limitations to what staff can do and how they can do it when there aren’t enough people with the right skills. Your point, “The only effective way to resolve such issues is to have all employees motivated, engaged, and participating in ongoing discussions of what they and others do, how it is all done, and how improvements can be made.” is a critical one and essential for co-creative problem solving as well as efficient and safe use of resources. And without a culture where engagement and quality improvement, nothing else will work consistently and for the long term. Organizations that need to create healthy cultures must do this first. Once this is in place I think leaders, prof and para prof staff will seek to understand and respect roles of others and overlap will provide creative solutions instead of unhealthy tension and self-preservation. In the moment, Sally will remind Sam about policy 108.456 and Sam will remind Bill. Not everyone will ever know everything but there will be a flow of information and individual and shared accountability. From here we can consider creative use of checklists such as randomly applying or the checklist of the week to keep staff on their toes or utilizing one for a period of time to address problem areas.

    Anyways, thank you for inspiring much thought and I look forward to what others have to say.

What are your thoughts?