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INTRODUCTION

Due to the fast growing emergency care demands, FL Healthcare Company wanted to review their policies and procedures; to ensure that the company can keep up with the demands of the industry. Through a company investigation, it was discovered that there was an increase in supply costs, decrease in censuss and increase in employee turnover. Fl Healthcare management relies on goal setting for employees to help the company attain it's goal. By setting specific levels of performance for employees, it gives direction to their effort, which will affect over all performance for both the employees and company (PSU, 2016). When goals are unreasonable, they can negativity affect the company. To help measure the validity of the current goals, the company generated surveys to patients and employees for insight why the issues were happening. The result of the surveys concluded that both patients and employees were unsatisfied.The problems that were prominent for the lack of satisfaction were under staffing, lack of proper qualifications of personnel, and the department had decreased in inefficiency and productivity. In an emergency room department there are many factors to keeps patients and employees satisfied, and the department running smoothly. Drake Bennett's article Ready,aim...fail (Bennett, 2009), demonstrates how ineffective or lack of goal setting can contribute to a decline of motivation and performance. It is imperative that effective goal-setting include goal mechanisms and S.M.A.R.T goal conditions, as shown in the article Properly set goals aid success (Gergen, Vanourek 2009).This case study utilizes Edwin Locke’s Goal-setting theory (PSU, 2016) to find solutions for the problems, which will generate the best possible outcomes to support FL Healthcare's success in achieving their goal.  

 

 

CASE STUDY

Background

Consumers today have many options for emergency healthcare due to the rapidly expanding industry. Fl Healthcare company 's has three local urban hospitals, that has in prior years had constantly met goals to keep up with this demand. However, due to the expansion of the industry to meet the increase need for emergency care, many urgent care centers opened in close proximity to Florida Healthcare Emergency Rooms. The company decided to evaluate its performance to make sure it can stay competitive and attain company goals. The company's main goal is to achieve financial strength to remain a viable option for the local populace. After seeing a recent issues with increase in cost, decrease in census and high employee turnover, the company decided to review the policies and procedures to see where the problems lie. The company sent surveys to patients and employees to determine the level of satisfactions with the company's current standards. After receiving the results of the surveys, it was apparent that the problems lie in the following areas under staffing, lack of proper qualifications of personnel, and the department had decreased in inefficiency and productivity. FL Healthcare was aware of how ineffective goals could be detrimental for a company's success. "The link between setting goals and achievement is the clearest there is" (Bennett, 2009). FL Healthcare decided to deploy, what they called, ‘the trifecta team” consisting of Managers A, B, and C responsible evaluating the current standards at each of the three locations and for implementing goals, which would lead and maintain positive outcome changes. Each member of this focused management team collaborated with ER management staff to determine the weakness in each emergency room. Manager A was responsible for emergency room 1, through investigation the deficits were how the emergency room handled case by case evaluation of patients. inadequate staffing, there was also lack of up to date training and certification and a lack of specialist physicians assigned to the emergency room. Manager B was assigned to emergency room 2, noticed complaining patients, in adequate staffing and lack of effective training and certification. Manager C was assigned to emergency room 3, the deficits that were observed ineffective staffing ratios, ineffective protocols for treatment and supplies, and disgruntled employees. After the 3 managers finished their observations and they concluded that older goals that were set were out dated to meet the demand of the industry, which was creating a delay in technology, which was impacting employee motivation and ultimately sacrificing excellence care standards for their patients.  Realizing that the goals that once worked, were now creating tunnel vision for employees, where they were concerned about how quickly to handle patients in an understaffed, unproductive and efficient department, it caused them to ignore other aspects of the job (PSU, 2016). Task persistence will allow employees a sense of accomplishment that motivates them to achieve. 

Solutions

Effective goal setting involves goal mechanisms to support goal setting. Goal mechanisms affect goal setting through direction and intensity,  this will allow employees to decide how much effort needs to be exerted based on the set guidelines and effort away from the behaviors that aren't relevant .Task persistence will allow employees a sense of accomplishment and search for successful strategies that motivates them to achieve goals (PSU, 2016). Initial patient discharge surveys indicated quality of care and satisfaction with the facility were low with an average score of 14 out of a possible 25. Initial surveys indicated that quality of care averages 2.7 out of five on the patient surveys. The patient survey asked 10 questions related to patient satisfaction and 5 questions related to ER experience.   The questions asked the patients to rate their satisfaction level from 1-5, 5 being the best, on care provided by staff, environment, timeliness, improvement or resolution of chief complaint, wait times and overall experience. In addition to those two, financial waste was an area for improvement identified by each of the management team in order to achieve the end state of long-term financial viability in the health care sector.  The trifecta team implemented Management by Objectives, a goal intervention that involves feedback from employees to create new frame of goals and a procedure for accessing performance for the goals set. Each team made their debut, providing catered breakfast, lunch, and dinner, and cordially mingling, but observing all at the same time.  As they introduced themselves to all department employees, an atmosphere of excitement and energy was apparent. On day two, collaboration began, with the consulting managers, and the ER management team, administrator, physician, and nurse, a presentation reviewing “How to create SMART goals” , focused the group and initiated the goal setting process. 

S.M.A.R.T Goals

When looking at a challenge such as the one laid out, it is important to ascertain whether or not it follows with basic ideologies following the goal-setting theory. S.M.A.R.T is a common acronym that helps break down the pieces of a specific situation to better see if, and where, there are any lapses in what is necessary to achieve optimum motivation. This particular scenario clearly displays each of the recommend aspects:

SPECIFIC - While we have various goals, they are all specific to their own individual needs and conducive to one larger goal, which is ultimately being a top competitor to surrounding Florida hospitals. Here, we are focusing on patient satisfaction, quality of care, and fiscal responsibility. 

MEASURABLE - Patient satisfaction was measured through surveys and the goal was to raise the average score within six months from the time that it was set fourth. The starting satisfaction score averaged at 3.1/5, with the ultimate goal being to increase that to 4.5 within the allotted period. 

Patient care was identified by mortality rate, length of stay, and subsequent ER visits. The starting average was 2.7/5 with the goal of increasing the average to a 4.5/5 within 4-6 months.

Financial indicators included productivity, salary/wages, and supply costs in relation to an established monthly budget.  Employee retention is also monitored and reported, as training costs were identified to be high.  

ASSIGNABLE - Goal-setting with a large staff like this might be difficult, but with assigning each specific area to a manager (A, B, and C), we are allowing those individuals to uphold the responsibility of ensuring that each piece of the puzzle fits together to make the goal attainable. In addition, the entire healthcare team will be assigned specific roles or areas of focus with daily audit responsibilities, supply inventory, census and patient to staff ratio. 

REALISTIC - Notice that the numbers decided upon are not specific or the best possible. Perfection is certainly something to strive for, but hardly a realistic goal. Manager B in determining the goal for patient satisfaction decided on a reasonable increase of about 30%, but it was also given a lengthy time period. The same can be said for fiscal responsibility; with a goal of reducing wasted supplies from 15% to 5%. 

TIME-RELATED - Goals are found to have “energizing function and mobilize effort (2016),” so this time needs to be able to fit within an amount of time that will allow for quick, but accurate feedback so that all participants can see the effects of their work. Each of these goals were laid out to be accomplished within a period of six months.

Outcomes

This example, as well as many others, of goal setting theory's effectiveness in an organizational setting is irrefutable.  As the simplest and most elegant theory of motivation, goal setting theory, which has an abundance of strong supporting research, holds overwhelmingly positive value (PSU WC 2016).  Suppose FL Healthcare would have sent a memo stating that the concern with customer satisfaction and requested that employees "do their best" to improve overall satisfaction of their customers to each of the directors of the three emergency departments, who in turn sent a similar memo to all of the healthcare team.  The results would probably not have been so effective.  Edwin Locke said, "when people are asked to do their best, they don't."  Rather, we understand that individuals thrive on specificity and need a clear path paved to where they want to go. He goes on to say the vagueness creates issue, and by giving people specific goals, direction, intensity, and persistence are added (Bennett 2009).  FL Healthcare was able to illustrate the effectiveness of goal setting with the application of SMART goals, as outcomes were significantly improved once implementation occurred. In the allotted six month time-frame that was set, two of the three goals were surpassed, and the third was just missed.  

By setting the tone for change in a positive way, FL Healthcare was on step closer to goal attainment by improving employee commitment.  Adequate staffing was determined to be the reason for an unusually long length of time under care and higher mortality rates. Managers A, in conjunction with ER management, hired five more nursing staff at each location and implemented a plan to have two doctors present during peak ER hours instead of just one.   Managers A provided feedback on a monthly basis to the ER staff on measures they could take to increase the level of care provided to patients.  Managers A also addressed Specialty physician coverage for the ER.The goal was to ensure the ER provided a specialty physician at this facility, if required, within 30 minutes of request.  The average wait time for care of 1.5 hours was determined to be the largest factor for decreased patient satisfaction. Managers B developed a triage plan to rate severity of emergency on a scale from 1-3, 1 referring to symptomatic cardiac/respiratory distress or arrest, or life threatening injury, 2 acute injuries requiring treatment or admission, 3 generalized complaints with non-life threatening presentation, as well as a triage nurse, who received training, and certification.  The triage plan was shown on surveys to increase patient satisfaction with the wait times while only reducing average wait times to only 1 hour due to the patient feeling like being triaged offered them a better chance of being seen faster. Managers B also observed an indifferent receptionist staff in the ER.  Managers B implemented a mandatory employee education program, which consisted of diversity training, effective communication training, and safety training. Because of their initiatives, Managers B were able to increase patient satisfaction from 3.1 to 4.1. Managers C focused their efforts on reducing financial waste within the organization. Low average wages compared to the regional average created high employee turnover and increased employee theft and waste of supplies.  On average, the hospitals were losing 15% of their supplies compared to what they should have been using given ER traffic. Managers C implemented the goal of reducing shrinkage to 5%.  Managers C implemented specific protocols for utilization of supplies. Employees received bar code scanners and scan enabled IDs to improve supply tracking and ER management weekly to track inventory levels and rate of usage and shrinkage. Managers C finally proposed an increase of pay for the nursing staff of $4 an hour to come in line with the regional average.  Because of his initiatives, shrinkage fell from 15% to 4%. Florida Healthcare provided a textbook example of how applying the goal-setting theory within a work place can produce overwhelmingly positive results. By breaking down the larger goal into lesser, more specific areas, it allowed for accountability and multiple levels of leadership. By setting these goals, the staff was not only aware of where they needed to go, but how they needed to get there. The survey demonstrated a significant increase in patients satisfaction.  The new supplies protocol was a great tool to monitor purchases and inventory.  Although monetary reward was not offered at the beginning of the study, as a the result of the successful outcome, management increased the nurses hourly wage.  The reward system increased performance and motivation by officially recognizing the best performing group and monthly recognition to the top two employees. Also, by introducing the staff to their new leaders and entering this new phase with a catered meal, they were able to achieve optimum goal acceptance; the first step in encouraged stronger performances (PSU, 2016). Employees had a reasonable expectancy of achieving the goal; as realistic goal attainment is more likely to motivate effort (Klein 1991). Management was also committed and willing to pull out all the stops to spread the enthusiasm.  Evidence has shown that more support from higher-level management is conducive to better increases in performance (Rodgers & Hunter, 1991).

 Managers A created the goal of raising this average score to 4 within 6 months. Managers A identified quality of care by mortality rate, length of time in care and recurrent visits with subsequent admissions. Because of the initiatives implemented by Managers A, patient care time declined from an average of 1.5 hours to 40 minutes and the rate of patients indicating they would return to the facility for care increased to 4.2. Managers B implemented a goal of the average score of 4.5 on the surveys within the six-month time frame. ER Management appointed an Employee Appreciation Team to ensure employee issues were addressed.  Monthly recognition awards were administered to 2 employees every month, one clinical, and one non-clinical, as well. After the six-month period, employee morale was higher and the average score on the patient surveys rose from 14 to 21. The goals for the FL Healthcare emergency rooms became more competitive with the local urgent care facilities, and were on the right track to remaining a viable healthcare option for the near future. Florida Healthcare provided a textbook example of how applying the goal-setting theory within a work place can produce overwhelmingly positive results. By breaking down the larger goal into lesser, more specific areas, it allowed for accountability and multiple levels of leadership. By setting these goals, the staff was not only aware of where they needed to go, but how they needed to get there. The survey demonstrated a significant increase in patients satisfaction.  The new supplies protocol was a great tool to monitor purchases and inventory.  Although monetary reward was not offered at the beginning of the study, as a the result of the successful outcome, management increased the nurses hourly wage.  The reward system increased performance and motivation by officially recognizing the best performing group and monthly recognition to the top two employees. Also, by introducing the staff to their new leaders and entering this new phase with a catered meal, they were able to achieve optimum goal acceptance; the first step in encouraged stronger performances (PSU, 2016). Employees had a reasonable expectancy of achieving the goal; as realistic goal attainment is more likely to motivate effort (Klein 1991). Management was also committed and willing to pull out all the stops to spread the enthusiasm.  Evidence has shown that more support from higher-level management is conducive to better increases in performance (Rodgers & Hunter, 1991). Feedback was also really important because there were discernible results within a relatively short amount of time that displayed the results of the effort. Given that the results are based on statistical data that was collected, the staff can feel assured that the findings are unbiased. As a whole, this will provide them with a certain amount of achievement and fulfillment, and help guide them toward bettering their system on even more levels.

This example, as well as many others, of goal setting theory's effectiveness in an organizational setting is irrefutable.  As the simplest and most elegant theory of motivation, goal setting theory, which has an abundance of strong supporting research, holds overwhelmingly positive value (PSU WC 2016).  Suppose FL Healthcare would have sent a memo stating that the concern with customer satisfaction and requested that employees "do their best" to improve overall satisfaction of their customers to each of the directors of the three emergency departments, who in turn sent a similar memo to all of the healthcare team.  The results would probably not have been so effective.  Edwin Locke said, "when people are asked to do their best, they don't."  Rather, we understand that individuals thrive on specificity and need a clear path paved to where they want to go. He goes on to say the vagueness creates issue, and by giving people specific goals, direction, intensity, and persistence are added (Bennett 2009).  FL Healthcare was able to illustrate the effectiveness of goal setting with the application of SMART goals, as outcomes were significantly improved once implementation occurred. In the allotted six month time-frame that was set, two of the three goals were surpassed, and the third was just missed.  

 

REFERENCES

Bennett (2009, March 15). Ready, aim...fail. Why setting goals can backfire. The Boston Globe, C1.

Gergen, C., & Vanourek, G. (2009, January 14). Properly set goals aid success. The Washington Times, B03.

Klein, H. (1991). Further evidence on the relationship between goal setting and expectancy theories. Organizational Behavior and Human Decision Processes 49: 230 –257

PSU, World Wide Campus. (2016). Psych 484, Lesson 6: Goal Setting. Retrieved from                             

https://psu.instructure.com/courses/1803780/modules/items/21267647

Locke, E. A. (1968). Toward a theory of task motivation and incentive. Organizational Behavior and Human Performance, 3, 157-189.

Locke, E. A. (2000). Motivation, cognition, and action: An analysis of studies of task goals and knowledge. Applied Psychology: An International Review, 49, 408-429.

Rodgers, R., & Hunter, J. E. (1991). Impact of management by objectives on organizational productivity. Journal of Applied Psychology, 76, 322-336

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2 Comments

  1. Hi Groupies,

    It seems like we have a good start, but to help wrap things up quickly and clear up the structure issues I have typed up an outline for the lay out, where we can take each section and revise to help get this on track. Please keep in mind I am open to edits and ordering on this outline. I have filled out the intro section and will be updating shortly. I suggest take a piece of what is there now and plugging it into this outline to see what is missing. Everything should have a spot here. Then we can delete the outline before submitting. I hope this helps. -Stephanie 

    Outline for Case Study: Goal-Setting

    Focus:

    • Identify 2 to 5 key problems
      • 1. Unsatisfied patients
      • 2. Unsatisfied Employees
      • 3. Rising costs
      • Why do these problems exist?
        • 1. Lack of effective goals
        • 2. Lack of motivation
        • 3. Lack of rewards
        • 4. Lack of technology
        • How are the problems effecting the organization?
          • Decrease in productivity
          • Decrease in efficiency
          • Increase in overhead costs
          • Loss of patients
          • High turn over
          • Who is responsible?
            • FL Healthcare

     

    Introduction:

    -        Attention-Getter statement 1-2 Sentences

    • Due to the fast growing emergency care demands, FL Healthcare Company wanted to review their policies and procedures; to ensure that the company can keep up with the demands of the industry.

    -        Identify key problems & issues

    • Through a company investigation the company the company discovered an increase in supply costs, decrease in patients and increase in turnover.
    • The company then generated surveys to patients and employees
    • The result of the surveys was that both patients and employees were unsatisfied
    • The reason for lack of satisfaction was patients felt a lack of care and long wait times. Employees felt understaffed, inefficient, and a lack of direction, goals and rewards system.

    -        Transition: In an emergency room department there are many factors to keeps the department running smoothly.

    -        Thesis (includes a summary of outcomes) 1-2 sentences.

    • Ineffective or lack of goal setting can contribute to a decline of motivation and performance, which why it is imperative that effective goal-setting include mechanisms and conditions.
    • This case study utilizes Edwin Locke’s Goal-setting theory (PSU, 2016) to find solutions for the best possible outcomes.

     

    Case Study

    1. Set the Scene

                1- Describe the Situation from start to finish No solutions or outcomes at this point

    -        The beginning

    -        The industry for emergency and urgent care is rapidly expanding many urgent care centers open in close proximity to Florida Healthcare Emergency Rooms. Allowing consumers many options for emergency healthcare. Fl Healthcare’s prominent quest is to ensure the company is achieving financial strength and to remain a viable option for the local populace. To gain insight and feedback FL Health care decided to send existing patients and employees’ surveys.

    -        DECRIBE THE MEASUREABLE RESULTS OF THE SURVEYS FACTs

    -        Explain what the results mean ie PROBLEMS and ISSUES

    -        PROVIDE research to back up why these problems and issues mean?

    Proposed solutions/Analysis:

    • Company provide a 3 person management team

    -        Provide one specific and realistic solution

    • Explain why the solution was chosen
    • Support with solid evidence
      • Concepts from L6
      • Outside research
      • Personal experience

    -        Provide one specific and realistic solution

    • Explain why the solution was chosen
    • Support with solid evidence
      • Concepts from L6
      • Outside research
      • Personal experience

    -        Provide one specific and realistic solution

    • Explain why the solution was chosen
    • Support with solid evidence
      • Concepts from L6
      • Outside research
      • Personal experience

    -        Continue this in the order of the problems listed until there is an effective solution proposed for every problem.

    Recommendations/Outcomes

    -        Describe How the concepts applied and implemented in the analysis will accomplish with each solution & Why

    -        Any recommendations for further action

    • What should be done & Who should do it.
      • Resurvey patient and employees in six months

               

               

               

     

        

     

     

  2. A clearer picture of what needs to go into this

    Focus:

    • Goal: to achieve financial strength to remain a viable option for the local populace.
    • Identify 2 to 5 key problems (these are what we need to find solutions too)
      • 1. Lack of effective goals
      • 2. Lack of motivation
      • 3. Lack of technology
      • Why do these problems exist?
        • Under staffing
        • Lack of proper training and certification
        • Lack of department efficiency and productivity
        • How are the problems effecting the organization? (Issue)
          • Increase in overhead costs
          • Loss of patients
          • High turn over
          • Who is responsible?
            • FL Healthcare and ineffective goals-setting.
            • Solutions (Goal-setting theory)
              • Why ineffective goal setting can be damaging to a company
              • Reference course work and research
              • Explain why setting effective goals is important
                • Explain 4 Goal Mechanisms a
                  • Apply to situation
                  • MBO’s
    • Explain how goal setting is essential for enhanced performance SMART
      •  Goal Conditions commitment and acceptance and participation
    • Apply Specify to the problems solution
      • Reference any coursework and references
    • Apply measureable (difficulty) to the problems in the solution
      • Reference any course work
    • Apply attainable to attainable to the situation
      • Reference any course work
      • Outcomes Time- related
        • How the solutions are going to be carried out to meet the goal
          • Include outcome feedback and process feedback
          • Any of the time relatable objects like salary and course training,
          • EA Team
          • Protocols
          • Monthly awards for motivation
          • Staffing rations