Case Analysis:

Guelph General Hospital

Golden Gate University

MBA 300

Key Strategic Issue/Problem Identification

 Jennifer Williams is the senior director of Inpatient Services at Guelph General

Hospital (GGH) and leading the GGH Process Improvement Program (GGHPIP)

implementation. The program is based on “lean” methodology strategy from

manufacturing operations philosophy, but it has been showing positive results from other

tested hospitals. Additionally, the program is approved by the government and supported

by the Ontario Ministry of Health and Long Term Care, but it has not been thoroughly

tested.

Their chief executive officer mandated the GGHPIP because of their deteriorating

culture and poor performance reviews. GGH was having process inefficiencies, and

communication issues, resulting in stressed staff and low morale. Their number of

patients is also increasing because of the demand in their area. However, their unsatisfied

patients are also increasing due to long waiting time. The patient waiting time is so long,

10.56 percent of their patients left without being seen (Cottrell et al., 2016, p. 2).

The GGHPIP was having some progress according to their performance metrics

after one year. However, GGH is still faced with the same obstacles during the program’s

implementation phase. In addition, they are having power dynamic issues and some of

their staff are not buying-in with GGHPIP, resulting in some some staff resigning.

Williams need to make some important decisions because their patient’s safety is at risk

and they are priority. She need to gather more information, further examine the situation,

and identify the root causes these issues so she can make effective decisions.

Alternatives Courses of Action

Williams is currently in the execution phase of the GGHPIP, implemented in

October 2009. She has seen positive progress in the defined metrics, with some backslide
in the most recent quarter, but has also received some negative feedback regarding patient

and staff satisfaction. This has led her to a decision point. She can eliminate the GGHPIP

and return to previous practice, stay the current course of action plan, modify the action

plan going forward, or come up with an entirely new action plan.

Eliminating the GGHIP may allow the GGH ED to return to the original

condition, with a possibility of satisfying the patients and staff who raised concerns about

the changes. This option could offer a known and steady state with which to evaluate any

future changes.

However, the EDPIP was part of a government mandate, so there could be

funding or licensing consequences for discontinuing the program. Furthermore, the

hospital’s metrics, including length of stay, percent of patients seen within target

timeframes, percent of patients that left without being seen, and average patient

satisfaction scores all improved with the GGHIP. Employee satisfaction scores improved

in score range in three categories, stayed the same in two, and decreased in only one

category following GGHPIP. The hospital would risk losing all the progress made if they

discontinue the program.

If Williams decides to stay her current course of action, she can continue to

evaluate progress or backslide on currently defined metrics. She can allow more time to

see if some of the concerns are related to discomfort in change and dissipate over time.

However, she may miss an early warning sign that the current course of action has some

problems and could miss the opportunity to redirect it at an early point. If this occurs,

she could completely lose buy-in before she has time to adjust the plan.
 Williams could maintain the current GGHPIP, but modify it going forward. She

could complete a redo loop by asking for the right feedback, collecting additional

information to clarify, and making adjustments with consideration to detailed feedback

and data (Tichy 2007). This may help realign the key stakeholders involved in this project

and identify problems that are surfacing before they become problems that threaten the

success of the project. It could also identify causes of the backslide and help maintain

future progress.

There is a risk in re-evaluating and modifying the current action plan. Williams

could potentially lose some support in the program if stakeholders lose confidence due to

the appearance of indecisiveness. There is also a risk that staff could get change fatigue.

Lastly, Williams could come up with an entirely new plan and move forward with

it. In doing this, she may be able to address problems that may be developing, but are not

clear or quantified. However, she would also loose demonstrated progress. Again, with

this option, she would face potential loss of confidence in performance improvement

plans and staff change fatigue, but likely a higher risk with this option.

Recommended Course of Action

Williams’ recommended course of action is to create a redo loop, which means

developing a small team that focuses on data gathering and continuous process

improvement in the area of patient satisfaction. Since the key stakeholders are patients,

this team will develop a methodology to measure patient satisfaction and determine best

practices to address each metric, if necessary.

Compared to alternative solutions, this is the best resolution because the GGHPIP

already addressed the sluggish internal processes within the hospital in 2009, and the new
focus should revolve around finding more data about patient satisfaction. A patient

advocate, or patient satisfaction specialist, who will keep the key stakeholders best

interest in mind, will chair the continuous process improvement team. The rest of the

team will be composed of nurses, doctors, and hospital administration employees. It is

recommended that the team be led by someone other than a doctor or nurse based on

historical negative power dynamics reported at GGH.

The goals of this alternative include finding data regarding overall patient

satisfaction while maintaining current or better metrics for internal practices. This data

gathering/process improvement cycle should be implemented within two months, with

expectation of more defined metrics at the end of the quarter.

Implementation/Action Plan

Within the next week, the new team members will be identified and have their first

meeting using the “inquiry approach which is a open process designed to generate

multiple alternatives, foster the exchange of ideas, and produce a well-tested solution”

(Garvin & Roberto, 2001). They will focus on critical processes to achieve the

GGHPIP’s vision with the patient as a key stakeholder. The team will consist of the

following personnel: a Patient Advocate Specialist, an ER and Inpatient Nurse, a ER and

Inpatient Physician, a Quality Improvement Officer, a Pharmacist, a Lab Officer and a

Radiology department manager. By having representation from each area, it will pinpoint

where the delays in patient care are occuring. The team will be required to gather internal

data from day-to-day operations, develop surveys for patients/staff members, and contact

hospitals who have used the LEAN technology to see if benchmarks exist. The team will

meet the following month to present the results of data collected, determine trends and
isolate bottlenecks in the process. The team will then formulate an actionable plan to be

implemented based off findings. The team leader will be the Patient Advocate Specialist

because they are usually the best point of contact for patient issues, complaints and

concerns. After the revised plan has been approved, successes/failures will be measured

by performance metrics and internal assessments for patients/employees. Process

improvements are a continual operation until the future state is achieved so obstacles and

challenges are inevitable. “Keeping people involved in the process is perhaps the most

crucial factor in making a decision and making it stick” (Garvin & Roberto, 2001). The

team will be required to meet monthly for the first three months, quarterly thereafter, and

Williams will be responsible for continuation of the celebration of short-term gains to

reward high performing departments.

Case Critique

This case analysis was very effective with decision making and critical thinking

topics. The story was very relevant because the problems can happen to real-world

scenarios which made the decision making and critical thinking exercises very realistic.

The readers were put in the position of Jennifer Williams to formulate a strategy that

happens in job settings. We were pushed to analyze the situation, brought out different

perspectives, and produced various ideas. The team later realized that the authors

intentionally left out some critical information to stimulate group discussions and deeper

analysis of the situation. Overall, this case study satisfied the academic concept of

applying techniques and identifying the elements of making good decisions.

References
Cottrell, J., Sathya, A., Allison, A., Korunsky, D., McGillis, S.A., & Nicols, M. (2016)

Guelph

General Hospital. Ivey Publishing

Garvin, D.A., & Roberto, M.A. (2001). What You Don’t Know About Making Decisions.

Harvard Business Review.

Tichy, N., Bennis, W. (2007). Making Judgement Calls: The Ultimate Act of Leadership.

Harvard Business Review.