1801004

OB-WAC

18010040
OB-WAC

Executive Summary:
Oneida Home Health Agency (OHHA) was first organized in 1947 as a public health agency
attending to the needs of the poor. Over the years the agency developed and is currently a small
Medicare-certified home health agency serving 11 communities. Rachel Nelson, the executive
director of OHHA was tasked with a series of important decisions regarding the agency. The
overall health of the company was not satisfactory as the agency had operated at a deficit for the
past three months particularly due to a fall in visits, underutilization of staff and short term
financing availed to meet the payrolls. In addition to this, there was also a conflict of the director
of nursing services Annemarie with the senior nurses of the staff resulting in a series of problems
which Rachel had to decide how to deal with in order to ensure smooth flow of operations within
the agency.
Statement of the Problem:
OHHA started from a small agency in 1947 to a multi-disciplinary healthcare facility over the
years under the guidance of Chuck who served as the first executive director. The number of
employees over the years grew from four to thirty including both part time and full time
employees. In the latter years of his service Chuck focused more on the funding for the agency
and in his own personal career development which left the management of the operations under
Dorothy who was the nursing director and had no background in the financial side of the
business. The departure of Chuck, soon followed by Dorothy, revealed a clearer picture on the
finances of the agency and also the mismanagement done by the former two employees. The
main problem facing the agency was that it was in deficit which was due to various reasons
including a large time for receivables, no accountability, high administration costs etc. One more
problem facing the agency was disconnect between the senior nurses and Annemarie. The
changes being made by the senior management were not very accepting by the senior nurses who
had their own way of doing things before and didnt understand the consequences of their
actions. The new organization structure added more layers of supervision for the nurses. There
was inefficiency in terms of productivity as no proper documentation was prepared, bills were
not collected on time and no proper scheduling was being done. In addition to this there were no
accountability measures and rewards were given without any performance measures resulting in

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no feedback to the employees in terms of how they were performing and what they could do to
improve in the future.
Causes of the Problems:
The agency over the years had passed through an evolutionary phase and was experiencing
different stages of growth. The two main factors which change in this are the size and age of the
organization. The methods being used in the smaller organization are not suitable as time passes
by. Traditional management practices that were appropriate for a smaller size and earlier time
no longer work and are brought under scrutiny by frustrated top-level managers and disillusioned
lower-level managers (Greiner, 1998). OHHA has also experienced a similar evolution and the
practices instilled by Chuck and Dorothy are no longer applicable. The initial functioning
focused more on direct patient care without any paperwork and restrictions. As the industry
changed in the 60s, new requirements were being made and the conventional methods of doing
things were no longer applicable. The agency however did not made the required changes which
resulted in a variety of problems leading to a deficit. Rachel was aware of the situation and
together with Annemarie made a series of changes. The first was the organization structure in
which divisions were formed and supervisors were brought in so that the senior management
could focus on broader issues. This was not well received by the senior nurses who previously
had direct access to the top and where supervision was lax, praise flowed freely, and criticism
was nonexistent. The nurses were not motivated which can be explained through the expectancy
model of motivation in Exhibit 1. Since there were no rewards for good performance and
everyone was getting an annual bonus on their anniversary date, the nurses were not motivated to
change their way of doing things and also they previously got all their problems fixed by
Dorothy which acted as a reinforcement in their way doing things. This could also be the reason
of why they were not able to effectively learn the problem-oriented medical record method as
they didnt believe that an effort in learning this could lead to a better performance.
The other reason of the problem was the conflict between Annemarie and the senior nurses. This
can be explained by the REB model and how the VABEs in Exhibit 2 had led to different
behaviors between the two parties. Annemarie had made her own assumptions in how nurses
should be, which included seeing nursing as a career and having a B.S degree. These
assumptions made her behave more favorable towards the newer staff and creating a rift with the
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old nurses who did not match these assumptions and saw it more as a profession having a
diploma and not wanting to pursue any further education. In addition to this, Annemarie had
developed an informal group with the new staff in which certain norms were established. The
older nurses were excluded from this group and started resenting Annemarie feeling she was
more biased towards the newer staff and therefore less willing to accept the newer changes.
Proposed Solutions:
There are a number of solutions which Rachel can implement in order to fix the problems being
faced by the agency. The first is to introduce a management by objectives method of
performance appraisal which is a little time consuming and costly to prepare but is well received
by both the subordinates and the supervisors. She could also introduce a bell curve performance
criteria in order to differentiate between the top and bottom performers which could lead to a
higher motivation but at the same time may become unfair if everyone is performing on a similar
level. She could also have coaching session with Annemarie and make her realize how her
behavior is creating a negative perception with the senior nurses and that she should be more
flexible and open with them. Rachel should encourage Annemarie to include the senior nurses in
her group meeting with the newer staff and listen to their ideas and concerns. Rachel can also
help establish a task force including all level of employees on how to train the staff using POMR
system, establish grievance methods for the future and how communication between the staff and
management can take place in the future. Rachel can also let go off the old nurses who are
creating a hostile work environment, which could solve the problem of the underutilization of
staff and the present conflict but which may be seen as unfair and demotivating for the rest of the
employees.

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Recommended Solution, Implementation & Justification:

Rachel should first establish a task force including all levels of staff in order to deal with the
current situation. This would include the representatives from the senior nurses and Annemarie
where both would voice their concerns and a more concrete and viable solution will take place.
Rachel should also encourage Annemarie to help build a collaborative culture with the senior
nurse and create norms which result in a higher productivity. This will make the senior nurses
feel more appreciated and a part of the team motivating them to learn new things and come up
with creative ideas which they can share with the group. Rachel should also have a coaching
session with Annemarie, to help her realize how her assumptions about the senior nurses are
creating a bias in her mind and leading to an unfavorable behavior from her side. She should
similarly have a conversation with the nurses on how they too could see from the side of
Annemarie and how she is in a position where changes being made by her are for the betterment
of the agency. Lastly, the MBO method will have a more focus oriented approach within the
organization and help nurses align their goals with the organization. This would motivate them as
their bonuses will be linked to their performance and give them a more clear direction in how
they could achieve the desired objectives which could also include their schedules.

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Exhibit 1

Exhibit 2

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Exhibit 3

Exhibit 4

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Exhibit 5

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