Workplace Reengineering, Reorganization, and Redesign: The Driving Force for

Workplace Reengineering, Reorganization, and Redesign

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• Introduction
• The Driving Force for Workplace Reengineering, Reorganization, and Redesign
• Change in the Organization
• Leading Change
• Averting Conflict Related to Change
• Strategic Planning, Visioning, and Reengineering
• Reengineering Measures
• Implementing Organizational Redesign
• Employee Readiness and Support
• Strategies for Success

• References

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The Driving Force for Workplace Reengineering, Reorganization, and Redesign

No business can be stagnant and expect to survive. An ongoing transformation process is the norm, and when business
does not evolve with the environment, failure results. Hospital business activity is influenced by a variety of internal and
external forces. Factors may include changes in reimbursement, a shortage or excess of labor, changes in the political
landscape, the economy, and others. Managers must be cognizant of the environment in which they function in order to
anticipate andrecognize the need for change and for facilities to remain viable entities.

External Forces

Organizations are currently analyzing trends in the healthcare environment as external factors come to bear on facilities.
The current hospital environment can expect a flat-to-obvious decline in inpatient volumes over the next 5-10 years
because of less invasive technologies and surgeries anda smoothing of demand, too, as more seniors maintain a healthy
lifestyle, including prevention and screening measures leading to early detection and lower acuity interventions. The
transition from inpatient- to outpatient-driven strategies will keepthe higher acuity patient in the inpatient setting with a
need for more intensive care beds and fewer traditional inpatient accommodations. Consumer cautiousness related to
cost of insurance, co-pays, and pharmaceuticals leads to fewer voluntary admissions in both inpatient and outpatient
areas (Advisory Board, 2003).

The outpatient areas can expect a surge in volume as inpatient admissions are averted, but the reimbursement to the
facility is significantly lowered. Emerging technologies have the potential to drive more change as technologies such as
positron emission testing can avert surgical interventions by indicating malignancy in advance of or in place of biopsy
prior to surgery. A continued rise in physician- or company-owned specialty hospitals and outpatient centers will siphon
patients from the traditional hospital setting, leading to a decline in both census and revenues as patients in the hospital
facility generally become more acute and provide lower margins. Mergers, acquisitions, and closures of facilities also
impact both inpatient and outpatient volumes as patient duplications or absence of services result (Advisory Board,
2003).

Changes in reimbursement are external factors with significant implications for volume shifts in the traditional hospital
facility. With their higher overhead costs, hospitals often lose managed care contracts to outpatient imaging centers or
physician offices or to other better-managed organizations willing to provide care at a lower price. Managed care
organizations (MCOs) are influenced by the purchasers of their product to deliver a lower cost of care. Business, the
underwriter of health care for much of the population, demands that the MCO negotiate lower rates to keep down the
business premium cost. Business also is offering to its employees graduated payment plans based on services selected.
Many employees are selecting lower premiums leading to higher co-pays, which may be more difficult for the hospital to
collect. Coupled with changes in managed care costs are the dramatic fluctuations in government-sponsored
reimbursement, such as Medicare and Medicaid. Annually, the centers for Medicare and Medicaid attempt to drive down
the reimbursement to both hospital and nonhospital settings. Of recent note has been the move to restructure physician
office reimbursement (lowering reimbursement) that may lead to an influx of chemotherapy patients from the physician
office outpatient setting back into the hospital outpatient setting. This type of movement would require a significant
change in the hospital, as most do not have sufficient infusion center capacity to handle this influx.

Being sensitive to the external forces that may influence a facility is important, but these same forces may translate to
internal impacts, which are equally important. For example, there are influencing factors that are difficult to segment into
external or internal forces on a consistent basis. Cultural impacts external to the facility can come from a shift in
demographics in the market. A large foreign or indigent population shift may cause internal forces that necessitate the
need for translators or accommodations to the cultural needs of this population. Societal needs in the community may
influence hospitals both externally and internally. A hospital losing money on obstetrics may not be able to close the
service if they are the only provider in the community. Although the internal need is to close the service in order to save
dollars, the external need is greater to keep the service. External forces may lead to internal influences or may stand
alone as a rationale for change. Once external forces are considered, the nurse manager should consider internal forces.

Internal Forces

Probably the most influential internal force impacting facilities is lowered margins, as reimbursement has steadily
declined over past years. Arguably, lowered reimbursement is external to the facility in most instances, but the use of
dollars can be determined as an internal factor that must be managed. As wages increased because of staff shortages
and technology costs increased with price increases from vendors, profits in the hospital were consumed. The use of
dollars in service delivery decisions (e.g., cardiology versus oncology) has significant internal ramifications. Coupled with
weakened infrastructure in the facility and sociopolitical factors within the management structure of the organization,
these declining fortunes of the hospital industry beg for redesign. Drucker (1993) described the incongruous economic
realities of industry that translate well to health care. In most industries, when volume grows, profitability also grows. It is
hard to understand why rising demand does not always equate to enhanced performance of the healthcare entity.
Looking from the most obvious financial impacts, whether internal or external, to less obvious influences supports the
need of the organization for change.

The culture and history of the organization can influence responses to factors interpreted as threatening within the facility.
The internal climate that exists within a facility can determine the ability of the staff to accept change in a positive
manner. Poor morale, lack of trust, and a feeling of disengagement with the organization are internal factors that
influence the organization's ability to reform and succeed. If staff reductions are the immediate response to internal
threats without a clear plan of action, staff may not trust the organization to appropriately handle future events.
Downsizing, whether through eliminated positions, department outsourcing, or layoffs, is an unfortunate trend in health
care and often leads to more detrimental effects than it prevents. A secretive senior management also may lead to
distrust on the part of employees as opposed to an open communication model in which staff are kept apprised of events
that may impact their future.

A thorough and ongoing assessment of external and internal factors exerting an influence on the organization is expected
of senior leadership to define a proactive plan of action in anticipation of strategic threats. By developing and
implementing a plan of action in advance of anticipated negative events, corrective measures may be initiated. Whether it
is the development of a strategic plan or a process improvement study, forward-thinking organizations are defining an
action plan to respond to their environment in a positive manner, which is designed to accomplish their goals. Strategic
planning follows a well-known process of setting goals and defining implementation plans based on previous activities, a
next step, so to speak. In contrast, reengineering is radical redesign implying a major upheaval within the facility. By
carefully defining a strategic approach to workplace reengineering, reorganization, and redesign and incorporating the
influences of external and internal factors, the process may be better managed, leading to a more positive outcome on
the facility and employees.

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• Introduction
• The Driving Force for Workplace
Reengineering, Reorganization, and
 Redesign
• Change in the Organization
• Leading Change
• Averting Conflict Related to Change
• Strategic Planning, Visioning, and
Reengineering
• Reengineering Measures
• Implementing Organizational Redesign
• Employee Readiness and Support

• Strategies for Success

Hospital A Hospital B Hospital C Hospital D Hospital E
FTEs 765 800 550 850 245
Lic beds 201 250 200 150 219
Beds srv 188 210 185 150 171
Pop 117,000 260,000 250,000 108,000 275,400
Est. cases 515 1,144 1,100 475 1,211
# cases 145 226 150 117 114
Tot chgs 1,856,597 3,403,766 3,027,752 2,259,375 2,032,809
Chg/case 12,804 15,061 20,185 19,311 17,832
Net rev 924,959 1,447,781 917,336 894,691 779,298
Net rev/case 6,379 6,406 6,116 7,647 6,836
Tot LOS 662 1,007 636 640 584
LOS/case 4.6 4.5 4.2 5.0 5.0
What forces are driving change in the industry?The forces that are driving change in the industry are, the entry of
Boston Market and Chick-fil-A's and other companies with different types of chicken. Boston Market was a new
restaurant chain that emphasized roasted rather than fried chicken. Boston Market created the image of an upscale
deli offering a healthy, "home-style" alternative to fried chicken and other fast foods. To make their different from
other competitive, Boston Market refused construct drive-through and established most of its units outside of
shopping malls rather than major city intersection that would attract large numbers of customer, Also the different
taste of chicken appealed to customer who preferred non-fried. Later Boston Market filled bankruptcy and
McDonalds acquired Boston Market. Which opened the industry to Popeye's Chicken as a major competitor to
KFC. Popeye's Chicken shifting the focus to Cajun fast food, launching a Louisiana Legends One-Pot Cajun Meal
of jambalaya, gumbo, shrimp, and crawfish etoufee. Also Church's also enter

Managing Change

In today's' economy, change is all-pervasive in organizations. It happens continuously and often at an alarming and rapid
speed. Because change has become such an everyday part of organizational dynamics, it is becoming increasingly
important to manage as any resistance to change by an organizations employees can actually cripple the organization.
Resistance is, though, an inevitable response to any major change. People will by their nature rush to defend the status qu
if they feel their security or status is threatened (Kotter J.P. 1996). If management does not understand, accept and make
effort to work with resistance, it can undermine even the most well intentioned and well conceived change effort (Coetsee
1999). Any attempt by management to change without creating and maintaining a climate that minimizes resistance and
encourages acceptance and support will be rendered fruitless. The purpose of this paper is to assist in minimizing or
alleviating the prevalence of resistance that is being experienced at DCDM due to the structural and cultural changes that
are currently taking place. The change process is centered on a significant de-layering and decentralization of the
 organization. The paper cont

Managing Change

Other examples of coercion include threats of transfer, loss of promotion, negative performance evaluation, or a poor
recommendation letter (Robbins S. ends that though change is an inevitable feature in an organizational setting, so too is
resistance to change. It is also important to remember that change involves to a great extent, an individuals psyche and ea
individual is different, his or her perceptions and reasons for resisting are also different (Robbins S. This can lead to
individuals resisting change as they fear the loss of power. o Threats to expertise V People feeling that their specialties wi
be threatened in the new organizational setting. This means that promoting the need for the change is not always sufficien
on its own for building support. Even in instances where the arguments for the change are clear, individuals may not trust
motives of those advocating the change (Robbins S. It is describe as an almost inevitable psychological and organizationa
response that seems to apply to any kind of change, ranging from the rather modest improvements to far-reaching change
and organization transformation (Levy A. Each different reason should not be underestimated as all issues raised and the
resistances they generate are valid. Either the problem is the proposal for change itself or mistakes made in the presentat
of the change (Maurer R. Resistance to change doesn't necessarily surface in standardized ways. The greater challenge i
managing implicit or deferred resistance. The purpose of this paper is to address the issue of organizational change at
DCDM and the resistance accompanying it and to formulate strategies that can better place the organization to deal with
resistance. Some topics in this essay:
Kotter JP, Robbins SP, Inertia Organizations, De Jager, Organizational Change, Management Debswana, Cooptation
Manipulation, Chang RY, Executive Summary, Conclusion Employee, resistance change, change process, robbins 1999,
robbins sp 1997, sp 1997, robbins sp, employee resistance, change robbins, organizational change, causes resistance,
kotter jp, kotter jp 1996, resistance change manifests, employee resistance change, change robbins sp,

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field devoted to understanding individual and group behavior, interpersonal processes, and organizational
dynamics" (Shermerhorn et. al, 2005). In other words, organizational behavior is the study and application of
knowledge about how people, individuals, and groups act within a company. Within the modern business world,
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change and adaptation in behaviors in order for an organization to take advantage of or work around these forces.
Organizations have both internal and external forces that impact the behaviors exhibited by the company, group, or
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globalization, restructuring, customer demand, company missions, fiscal policies, technology, and increases in
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Some topics in this essay:
Grainger OSS, Mutual Funds, Mutual Division, Jackson Hewitt, Policies Fiscal, Jackson Hewitt's, Hunt
Osborn, Services Restructuring, Abstract Organizational, Forces Organizations, external forces,
organizational behavior, jackson hewitt, tax preparation, fiscal policies, organizational behaviors, internal
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bank york mutual, tj maxx stores, external forces economy,

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