ORGANIZATIONAL ANALYSIS

Coastal Harbor Health System Organizational Analysis Abiola Stella Oloyede Georgia Southern University

ORGANIZATIONAL ANALYSIS

Coastal Harbor Health System Organizational Analysis Starting Point The mission of Coastal Harbor Health System is, to provide superior quality health care services that: Patients recommend to families and friends, physicians prefer for their patients, purchasers select for their clients, employees are proud of, and investors seek for long-term results. We will realize this vision through our commitment to the following principles: service excellence, continuous improvement in measurable ways, employee development, ethical and fair treatment of all, teamwork, compassion, and innovation in service delivery (Coastal Harbor Health System, 2013, pg. 1). Coastal Harbor Health System delivers the service of mental health and behavioral treatment to children, adults, and military personnel in the community at-large. Their customers are patients who have challenges functioning well in everyday life due to psychiatric issues, substance abuse, or a psychosocial crisis. The facilitys product is offered for acute and residential care in a collaborative fashion: psychoeducational and process psychotherapy groups, individual psychotherapy, recreational therapy, family therapy, and medication. Since Coastal Harbor is accredited by Joint Commission, an accrediting and certifying non-profit organization for health care, there are many policies and practices that must be strictly adhered to. The established policies and compliance procedures are referred to as Service Excellence standards, and are congruent with the organizations mission. All policies aim to uphold the professional and reliable service that Coastal Harbor desires to provide. From confidentiality requires to the social media policy, there is a proper way to handle every situation at Coastal Harbor. The policies are enforced at employee orientation, and it is required that all

ORGANIZATIONAL ANALYSIS new hires sign an agreement to adhere to the organizations policies. Most importantly, policy compliance is enforced in the actual work environment. Joint Commission visits the facilities every six months to ensure that paperwork, procedures, and the like are being followed

completely. So, there is a daily audit conducted by a facility Corporate Officer to monitor proper documentation, filing, and confidentiality practices. If an employee fails to adhere to any of the Service Excellence standards, the organization reserves the right to implement corrective action up to, and including, immediate employment termination. The counselors role is clearly defined as the authority for psychosocial crises, mental illness, and substance abuse treatment. While the psychiatrist orders the administration of the medication to the nurses, the therapists work in collaboration with the psychiatrist to develop an effective treatment plan for the patient. The therapists role is to assesses and counsels clients regarding psychological or emotional problems and develops and implements therapeutic treatment plans and discharge safety plans; educate families and clients regarding diagnoses and safety planning; participate in treatment team sessions with medical and nursing staff to provide input regarding patient care and treatment interventions; contact and schedule counseling sessions with family, significant others, and involved agencies; communicate with current and potential referral sources in a professional manner, seeking to address any concerns that arise in a timely manner with the patient, and if applicable, the family in developing a safety plan prior to discharge and review this with patient, family, and aftercare provider. In the event that the patient or their family wants to know details about the medication being given, the therapist is no longer in the position to relay such information; that is the role of the med-nurse and psychiatrist. Even non-licensed therapist is supervised by the resident LPC, in

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which he or she oversees their progress; enforces policies and their changes; and facilitates therapeutic growth. In my time interning with the organization, I have seen a strict congruence between the written job expectations of a therapist and the therapists actual role. Depending on what ones job title is, there are different and designated line-staff relationships. Over all Coastal Harbor employees is the CEO, Ray Heckerman. The medical director is Dr. Edward Merves, and he oversees the six psychiatrists spread between both of the organizations facilities. Each patient unit has its own attending doctor who oversees the nurses. The nurses give orders to the Mental Health Technicians, who monitor the patients twenty-four hours a day, every day. As aforementioned, for the therapists, Jerri Frost, LCSW is the Therapist Director. For the adult building, the building is structured as a large ranch-style house. Its surrounding is decorated with real shrubs, trees, and various other plants. The first impression when entering the adult building is that you are in a quiet business. It also gives off the feel of an assisted living home. The receptionist is very friendly and helpful to all who walk in. There are multiple moderate-security doors that barricade patients from attempting to go AWOL. The complex is user-friendly, easy to navigate, well-lit, and spacious. There is a permanent stench of stale coffee, rotting food, and unclean people that is spread throughout the building. The childrens building looks like a four-story school that has been renovated into a behavioral rehabilitation facility. The grounds are well-groomed, it is quiet outside, and the parking lot is wide open. Walking into the building, there is a living room style foyer for waiting families and visitors. Human Resources and administration are housed in the front of the building of both facilities, and overlooks the waiting lobbies. The office of the CEO, medical

ORGANIZATIONAL ANALYSIS director, and all other directors are spread throughout the first floor of the childrens building.

Walking through the building, the childrens facility has an elementary boarding school feel to it; there is an indoor gymnasium, cafeteria, whimsical cartoon laminates on the wall promoting healthy and good behaviors, and each units hall has a positive word attributed to it (i.e. Love Hall, Friendship Hall, Compassion Hall, etc.). Overall, Coastal Harbor presents itself as a peaceful and warm environment from which to receive treatment. It is common knowledge that Ray is very open and presents himself to be accessible to all employees when he is in the building. He is said to have an open-door policy. The working relationships between staff appear to be cohesive and amiable. The same-level staff works collaboratively with one another to ensure patient-satisfaction while in treatment. For instance, there are always two therapists on staff for each unit; at least three nurses are at the nurses station; and there are always three MHTs on the unit. Usually the nurses are patient with the patients, and participate in the wellness goals for the patients with the therapists and doctors. Depending on the MHT, there is a range of participative and welcoming personalities. Some MHTs are extremely willing to engage in the patients treatments and become a stable support for them, and some just come to do their job and go home. Such MHTs like the latter do not usually last long at Coastal Harbor; they either leave by their own frustrated will or fail to adhere to Service Excellence standards, and are terminated. Since the therapists deal with the brunt of the emotional and mental crises of the patients, they tend to be more friendly and patient with the patients than other staff, but they also get the most comfortable and cross the line of respect with some of the extreme patients.

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Since many of the patients do not willingly choose to be in treatment, their attitudes toward staff fluctuates depending on the length of their stay, what state of mind they are in, and who they are interacting with. Nevertheless, by the time patients are in a stable emotional, mental, and physical state to leave, there is a general air of gratitude for their treatment and those who helped them, and a sense of loss of a great support system. That is Coastal Harbors staff in a nutshell: a interdependent team that provides a service of health care to those in dire need. Organizational Processes. Patients are assigned an individual therapist who handles all aspects of their treatment. Therefore, the patient has direct daily access to his or her therapist, as does the patients authorized family member or support person. However, depending on the units census, the patient is one of four to ten total patients that the therapist has for a case load. So, it can become a struggle for patients to receive as much individual counseling and attention as they desire; individual patient-therapist time can range from fifteen minutes to two hours depending on the patients current need or crisis. The therapists communicate with the Therapist Director, unit psychiatrist, and discharge nurse. The discharge nurse will then communicate with the patient to prepare for discharge. Until then, the patients treatment team (comprised of a unit nurse, assigned therapist, recreational therapist, and psychiatrist) will be in direct daily contact with the patient for an hour to discuss treatment updates, verify safety, and ensure the administration of appropriate medication, and whatever else the patient needs. Administration does not have much contact with the public as it pertains to current patients. There is a marketing team who handles all of the organizations advertisements, and who seeks out purchasers, physicians, investors, etc. digitally and through community outreach.

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Decisions are only made when they are deemed necessary, as the directors see fit. The person(s) who makes certain decisions depends on the decision that needs to be made. For instance, the CEO makes the executive decisions, and they are carried out by all employees as they pertain to each employees role. All medication decisions are made by the unit psychiatrist. The med nurse carries the orders out by distributing the prescribed medications to the patients. The patients treatment plans are decided upon by their assigned therapist, in conjunction with the treatment team. The therapists ensure that the treatment plans are being adhered to and then update them. Many things are evaluated at Coastal Harbor Health System. For counseling patients, mental health, substance abuse and dependency, and emotional crises are evaluated through comprehensive assessments. The patients, their family members, physicians, caregivers can all have input as to what is included in the assessment. However, the patient is usually the primary source of sometimes credible information. If the patient is incapable of providing necessary information, then a primary contact is referred to for as much information as they can give. Administration is evaluated through customer satisfaction evaluations, as well as employee evaluations. The information gathered from the evaluations is then compiled by a Corporate Compliance Officer, and is imputed into a computerized system. The data is then sent to the corporate office in which a data report is made and distributed back to Coastal Harbor administration as a progress report. The report is considered confidential, proprietary documentation, and is thus not offered for release to the public. As previously alluded to, power is distributed based on who has been at Coastal Harbor longer. For instance, the therapists distribute their power over the interns. It is rarely in a

ORGANIZATIONAL ANALYSIS negative way though. I have come to notice that the nurses impose their power on the MHTs, however, I am unaware of whether or not they have official right to do so. Everyone exerts their power over the patients, but all the staff has the authority to do so. Sometimes it can lean on the disrespectful side, but never to the point where I have seen it to be completely offensive to patients rights. I have not seen any conflict amongst the staff; as stated earlier, everyone works

well together and is relatively cohesive. There are no perceived levels of trust/distrust. However, there is one therapist that is hypersensitive, and she believes that most of the nurses and patients do not like her. So, she tries to assert her position as a credible staff member as often as possible. No one really pays attention to her when she does so though. The informal leaders is one nurse who has a very counselor-style approach to her interaction with patients, an MHT who is very gentle and fun with the patients, and one therapist who takes no nonsense from anyone. These are the people that the patients usually gravitate toward, so the other staff members know that if they need a patient to do something without hesitation, those three women are the ones to call. I am unaware of any crises that sparked and molded the organization, and there are rarely any environmental changes. Coastal Harbor is a very stable environment; not many people change their disposition because the patients are always unstable and in a state of crisis. So, the informal climate is for staff to take pride in remaining calm in all high-stress situations. People interested in working at Coastal Harbor are able to visit the organizations website and view available job positions. Once they apply, they may be granted an interview. I was informed that not many people are granted an interview. If they are hired, they will attend the new-hire orientation. I am not privy to any hiring biases or special privileges.

ORGANIZATIONAL ANALYSIS Coastal Harbors famous symbol is the blue suspension bridge that is used on all of their letterheads, uniforms, and marketing publications. Every month the CEO hosts a town hall meeting for each building. At these meetings, the staff is able to come and discuss concerns,

learn about organizational changes and updates, win prizes for work performance, and meet new hires. This is all done in an informal manner, though everyone is still on the clock. Nurses and MHTs work a typical eight-hour hospital shift (7a-3p; 3p-11p; 11p-7a), everyone else works a typical workday (9a-5p), with individual shift times fluctuating as needed. I am unaware of any taboo subjects, and I have not perceived any negative beliefs at Coastal Harbor; the consensus is that the patients health care comes first. Service Excellence and FISH! Philosophy are two slogans and ideologies that Coastal Harbor takes seriously and enforces. Service Excellence posters are plastered all over the building, and FISH! Philosophy certificates are given to highly rated employees as an incentive to keep up the great work at every town hall meeting. Depending on the job role, there is an occupational culture that is passed on that unofficially tells new hires how things are really done. However, there is no perceived collective unconscious because everyone works collaboratively in different job roles. Also, since there is a daily and bi-annual audit, no one truly blindly follows anything but protocol that is compliant with Coastal Harbors policies and standards. The biggest m yth is that everyone admitted into a mental health facility is insane and violent; that is the furthest from the truth. It has been supported that sometimes people just need help learning how to positively cope with negative life occurrences. I think the only human need not being met at Coastal Harbor (as it relates to counseling) is more patient-therapist contact. The therapists have so much to attend to with such large

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caseloads that they are not always able to give the patients the direct time that they need. Every six months, every employee must renew Coastal Harbors Handle with Care safety training; every employee must be CPR trained annually; and for counselors, there is a monthly counseling techniques training. These trainings are mandatory, so no one is excluded from participating unless released by a doctors consent. Every task that a Coastal Harbor employee performs has a direct connection to meeting the needs of the patients. Even though there are those who will sometimes complain about a new policy or current procedure, everyone seems to adapt seemingly well and quickly. I am unsure as to how the tasks are integrated into the employees needs, other than for professional development.

Format Coastal Harbors presenting problem is the desensitization of some staff members. Some symptoms that detail such desensitization are the staffs impatient replies to patients; the staffs melancholy disposition throughout their shift; and the complaints of feeling dismissed that some express weekly. As an intern, I have noticed that interns uphold a fresher, more empathic rapport with the patients than most staff. The intern supervisor and licensed counselor hold the same perspective concerning patient care as the interns, but that is not always shared by some of the other therapists. The underlying issues are that burnout is very easy for Coastal Harbor staff, and the workload is so heavy that the staff is not able to catch their breaths while performing. I would diagnose Coastal Harbor Health Systems staff with Acute Stress Disorder. In my time at this facility, I have come to ascertain that it takes approximately three to six weeks for new hires to become acclimated, and thus, desensitized to the chaotic atmosphere of Coastal Harbor. The desensitization is a coping mechanism that helps the staff deal with all of the

ORGANIZATIONAL ANALYSIS sensitive to high-risk cases they see on a daily basis. Hence, the staffs display usual display of

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such lackluster disposition. Their lack of emotional responsiveness is attributed to the amount of crises they manage in an eight-hour shift. Feelings of stress interfere with the staffs ability to function effectively with the high-stress environment and the heavy caseloads. Some of the staff experiences a sense of numbing or detachment when supervising patients who are on forty-eight hour suicide risk alert. This has led to a reduced sense of their work environment, even though they must remain alert of patient needs at all times. Some staff will purposefully ignore patients to avoid being exposed to thoughts, emotions, conversations, etc. that are attached to the patients stories and disorders. As a counselor, I would help Coastal Harbor manage its acute stress by providing psychotherapy groups for staff members that teach deep-breathing exercises, meaningful meditation, oxygen therapy, and other support groups twice a week. This will help the staffs anxiety decrease because they will be able to process through their individual and collective stressors, be it work-related or personal. To increase productivity, I would implement a behavior modification reward system, in which good work is rewarded with Coastal Cash. At the end of each month, staff members are able to cash in their accrued Coastal Cash for several work incentives such as thirty minutes extra of break time, a half workday, a gift card, or whatever else the organization deems feasible to provide as rewards. Likewise, Coastal Cash can be used to pay fines for not upholding Service Excellence standards, policies, and other important clerical procedures (misfiling documents; not documenting important patient interactions; not completing paperwork within appropriate legal time, etc.) that affect Joint Commission auditing. I believe that the reward system would definitely boost company morale and productivity.

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To further encourage the organization to keep up the good work meeting their goals and mission, I would survey staff on what motivates them to do their work with the organization, and then facilitate weekly reminder groups that keep staff focused on why they chose to work and stay with Coastal Harbor Health System. The aforementioned interventions will help with staffs ability to handle crisis, grow professionally, and develop a work environment that is conducive to the organizations mission of providing positive patient health care.

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References Coastal Harbor Health System. (2013). Coastal Harbor Health System Employee Handbook. Savannah: Coastal Harbor Health System.