Change And Culture In The Public Health Field Free Essay

Introduction

Most hospitals today face the challenge of limited resources and as such, seek to increase their chances of survival by minimizing duplication and improving efficiency especially by forming mergers and consolidations (Anderson, 1991). Additionally, increased competition due to prospective payment system is yet another factor that compels hospitals to merge their operations for a common goal. In any case, mergers play significant role of ensuring that professional services are rendered, efficient patient care activities are given, and proper management is conducted. Besides, mergers generate a culture whereby merged entities gain full control of all the activities taking place in the hospital and make great sales. However, mergers can affect hospital operations. The diverse operations that can be affected include staffing, efficiency and operating practices. It can also affect the performance of workers as expounded in the essay especially if merging hospitals were initially rival competitors. This may put managers in a hard-hitting position of ensuring that working behavior is thoroughly controlled after the process of merging. On the same note, it is commonplace to witness workers change their attitudes at workplace especially after two organizations merge. In fact, some of them may be disgruntled or completely uncontrollable. This essay will examine impacts of mergers on sales and efficiency in performance of workers with cross reference to a hospital setting.

Impacts of sale on the culture of the newly combined organization

As already mentioned, most hospitals today face managerial difficulties on how to harness limited resources which may be both human capital and financial resources. Hence, they seek to increase survival chances by reduce duplication, improving efficiency and overcoming competition and other exogenous pressures through mergers and consolidations (Anderson, 1991). The rationale behind such an initiative is to effectively compete in health care market. To say the least, it is imperative to note that merger of hospitals improve operating efficiency thereby effecting growth in terms of sales. On the same note, the market power gained by merged hospitals is higher than that of individual healthcare unit. In this case, a poor performing hospital joined with a better performing partner will gain in terms of sale by pooling their resources and skills together. This also will be attributed to one of the partner’s management expertise. Additionally, since the merged hospitals were previously in competition, their market power could have been high. Therefore, the impact on sales after merging is highly likely to be higher in addition to the fact that overlapping of services being offered by both partners is likely to be experienced.

Roles of a middle manager in ensuring that the combined staff works together to provide quality care without taking on a competitive stance

Mergers, as already examined, may affect the level of performance of a hospital. Due to myriad of difficulties that may arise in key primary operational areas, quality of service rendered by the staff of a merged hospital may be affected. This calls for middle level managers to play critical role of ensuring that the integrated and combined staff work as a unit to give quality services despite their differences (Smith, 2001). It is instructive to understand that operating efficiency, personnel practices and scale of operations of staff are strained when they are merged owing to their different backgrounds. According to Smith (2001), Peter Senge, a strategist, indicates that managers should play the role of ensuring that there is learning in their organizations. He observes that this is significant where individuals intend to achieve a common goal, have collective aspirations and expansive thinking patterns (Smith, 2001). In this sense, a middle manager in a merger should create awareness to the staff on the importance of being productive, adaptive and flexible when working together, as this is vital for organizational success.

As earlier discussed, when mergers are incompatible due to asymmetry or dissimilarity in size, members of staff may find themselves in a non-conducive environment where there is unequal distribution of power and a competitive attitude (Cameron, Este & Worthington, 2010). The latter can be as a result of competition in offering health care services prior to merging. Staff members may carry that attitude into a merged organization. Therefore, there is need for a middle manager to apply basic principles of guiding and directing entire workforce on the importance of team work and group dynamics. This may be achieved through team learning, developing shared vision, creating mental models, personal mastery and systems thinking (Smith, 2001). The latter is essential in uniting staff by focusing on a long-term view. Moreover, a middle level manager should seek solution to existing differences among workers by understanding that change is a dynamic process. This will prompt managers to devise strategies that will provide long term improvement in healthcare.

Additionally, mental models can be used to foster changes and develop new orientations among members of staff. A manager should encourage openness among working staff, retain control and coordination as well as distribute roles responsibly (Smith, 2001). Furthermore, the difference existing among the merged staff can be overcome when a manager creates a common goal for an organization. According to Smith (2010), a staff that has shared and common goals has the capacity to work together. Such a goal creates a sense of long-term responsibility to the staff. It is important to note that goals encourage teamwork, innovation and experimentation.

How the organization will look like in terms of system and shape

A hospital merger is shaped when one or two hospitals that are independent coalesce with another either through absorption of a dissolved hospital or when participating hospitals dissolve to create a new one. According to research studies, there are two significant causes of hospital mergers. The causes include the need to form a first-class management base, and to achieve a requisite investment. When hospitals merge, their systems and shape changes. Some of the developments that take place in its system include a new and specialized technical staff, an augmented support to attain desired clinical services, heightened market shares and ability to acquire technology that is cost effective (Anderson, 1991). A merger entails full integration and combination of resources of merging hospitals. Theoretically, this impacts heavily on the shape and system of an organization in terms of augmentation and performance. Even though mergers are significant in rendering professional services, patient care activities, management and support services, it is instructive to comprehend that it affects the system of activities in hospitals (Morgan et al., 2010). Such areas include staffing, efficiency as well as scale of operations.

The preliminary stage of merging hospitals involves legally joining the staff and other resources. Even though the management may perhaps set up strategies and measures to protect activities, subgroups and individuals, issues such as a competitive attitude and rivalry that existed prior to merging may be a constraint to achieving efficient services and integration (Anderson, 1991). However, it is imperative to observe that the practice that involves integrating two formerly independent hospitals that were previously competitors affects the system of the hospital in terms of coordination, communication, strategic direction and corporate culture. Additionally, cases of discrepancies and dissimilarity in interest are some of the issues that are bound to arise within a merger.

Implementing changes in the merged system and shaping the organization in terms of staffing, staffing practices and operations may be cumbersome. This can be attributed to the time period of formation, similarity in ownership and dissimilarity in size of the merged hospitals. The latter is a common cause of unequal power distribution between the merged hospitals (Anderson, 1991). When size is asymmetrical, the powerful one will be in command of the operation system of the entire hospital by exercising greater leverage. As a result, the other party in a merger may effectively resist that kind of operating practice. Such an organization will show indications of difficulty in bringing integrative changes in its system. Dissimilarity in size might also be seen in the total number of personnel, average number of nurses per daily census and increased number of beds. It is instructive to note that this affects staffing and capacity practices. In a situation where there is a similarity in ownership, the system of operation will be conducive. It will be easier to orientate strategies, missions and cultures. Additionally, carrying out operational changes, motivating and integrating workers to effect operations will be possible.

The systems of a merged hospital will work effectively towards achieving of a common goal if they are compatible (Anderson, 1991). This will make it easy for them to implement new changes. Conversely, without compatibility between the staff and the operating systems due to enmity or competition, instances of greater resistance to changes and other disparities will affect performance, and this will require more energy and time to resolve.

Conclusion

To sum up, this study examined various changes and cultural practices that may be observed when hospitals that were previously competing, and of dissimilar strengths and quality, merge. As indicated in the body of the text, primary areas affected by such mergers include staffing, efficiency and operating practices. Initiating changes in these areas and having the staff working together despite their differences is inhibited by factors such as merger period, ownership similarity and size similarity and/or differences. This calls for setting up of strategies and measures to cope with emerging and inevitable challenges. A middle manager therefore, has a role of ensuring that the entire workforce pulls together as a team in attaining common goal. This can be achieved through organizational learning through which middle level managers play integral role a role of initiating team learning, creating shared vision as well as mental models. It is also worth to mention that while mergers among formerly competing organizations may prove to be quite a challenge both in terms of harmonizing managerial competences and developing common thinking among workers, the initiative may widen opportunity for further profitable ventures bearing in mind that each partner will inject new ideas into the newly formed organization. Definitely, the overall performance of the merger is highly likely to be higher than operations of a single entity.

References

Anderson, H. J. (1991). Hospitals Face Tough Issues in Years Following Mergers. Hospitals 65 (18), 24-32.

Cameron, P. J., Este, D. C. & Worthington, C. A. (2010). Canadian Journal of Public Health 101(1), 79-82.

Morgan, G. B. et al. (2010). Job Satisfaction in the Home Health Care Context: Validating a Customized Instrument for Application/Practitioner application. Journal of Healthcare Management, 55(1), 11-24.

Smith, M. K. (2001). Peter Senge and the learning organization. Web.

Annotated Bibliography: Hypertension And Kidneys

Agarwal, R. (2005). Hypertension and survival in chronic hemodialysis patients-past lessons and future opportunities. Kidney International, 67, 1-13.

This study review looks at reverse epidemiology between hypertension and mortality among chronic hemodialysis patients. The author conducts a critical analysis of the most recent research studies, which show that there is a positive improvement among chronic hemodialysis patients when systolic blood pressure is controlled prior to treatment. Therefore, there is the need to control hypertension in hypertensive hemodialysis patients (Agarwal, 2005, pp. 1-10). The credibility of this source lies on the fact that the author is an experienced associate professor of medicine at Indiana University School of Medicine, and thus his experience in nephrology forms the basis of the study. And since, the current research paper entails looking into the direct link between hypertension and the kidney; this source will form a useful theoretical framework in terms of showing the positive impact of controlling hypertension before commencing hemodialysis.

Center for Disease Control and Prevention. (2010). National chronic kidney disease fact sheet: General information and national estimates on chronic kidney in the United States, 2010. Atlanta, GA: U.S. Department of Health and Human Services, CDC.

This fact sheet looks at the prevalence of Chronic Kidney Disease (CKD) among adults in the U.S., the risk factors in the development and progression of CKD, the health consequences of CKD, and the preventative strategies for CKD. In this study, it is shown that hypertension is a major risk factor in the development and progression of CKD including other underlying health consequences such as kidney failure, cardiovascular disease, and premature deaths (Center for Disease and Prevention, 2010). This source is credible because it is a joint study between CDC, Agency for Healthcare Research and Quality, and American Society of Nephrology among other health promotion agencies. Accordingly, this study will form the basis of the current research paper considering that it provides useful and factual data regarding the direct relationship between hypertension and kidney complications particularly kidney failure.

Hughson, M.D., Douglas-Denton, R., Bertram, J.F. & Hoy, W.E. (2006). Hypertension, glomerular number, and birth weight in African Americans and white subjects in the southeastern United States. Kidney International, 69, 671-678.

The study aims at showing the relationship between hypertension and the decreased nephron number among participants from southeastern U.S. The study, which involved 62 African-Americans and 60 whites, was set to show the link between the total glomerular number (Nglom) and the mean arterial blood pressure (MAP). Through critical analysis of the data obtained, the researchers show that there is a direct link between low nephron number and the development of hypertension among the whites compared to African Americans (Hughson et al., 2006, pp. 671-677). This source is very reliable considering that it is based on primary data and extensive analyses conducted by researchers from the University of Mississippi Medical Center, Monash University, and the Centre for Chronic Disease. Here, it is certain that this source will inform the current research paper in terms of providing the role of kidney morphology and functionality in the development of hypertension as opposed to the foregoing sources, which show the impact of hypertension on the kidney.

Lea, J. et al. (2005). The relationship between magnitude of protenuria reduction and risk of end-stage renal disease: Results of the African American study of kidney disease and hypertension. Arch Intern Med., 165 (8), 947-53.

Studies note that there is a direct link between the degree of protenuria and the gradual increase in the development and progress of the end-stage renal disease. Thus, this study aims at investigating the relationship between baseline/changes in the level of protenuria and the rate of glomerular filtration (GFR) relative to the development/progression of hypertensive renal diseases in the absence of other risk factors such as diabetes. This study, which involves post hoc analysis of data regarding 1094 hypertensive kidney disease patients from the African-American communities, shows that the preliminary changes in the degree of protenuria from the baseline levels within a period of six months occasions the development/progression of hypertensive renal disease at various GFRs (Lea et al., 2005, pp. 947-950). This particular source is plausible because it utilizes primary data and critical analysis based on the experience of researchers drawn from the department of medicine in Emory University School of Medicine. Conversely, this study will also form the basis of the current research paper in that it shows the relationship between kidney functionality and the progress hypertension-related kidney complications.

O’Rourke, M.F. & Safar, M.E. (2005). Relationship between aortic stiffening and microvascular disease in brain and kidney: Cause and logic of therapy. Hypertension, 46, 200-204.

The study notes that there is a direct link between the damage of microvascular networks in the kidney and various aspects of hypertension such as pulse pressure and the augmentation index. This study reviews epidemiological studies and other clinical trials to show the functioning of the human arterial tree in normal circumstances, and under aging conditions. It also shows the impact of arterial stiffening on the renal microvasculature besides providing the logical therapeutic interventions required to reverse the kidney complications. Here, the continuous exposure of the delicate kidney microvasculature to fluctuations of pulse pressure due to arterial stiffening is implicated in the development of renal microvascular damage (O’Rourke & Safar, 2005, pp. 200-204). This source draws its credibility from the fact that the researchers embark on reviewing the most recent peer-reviewed literature studies besides incorporating many years of experience as clinicians in the critical analysis of the studies. As a result, this source will aid the critical development of the current research paper mainly through showing the long-term effect of hypertension on the kidney structure and functionality.

Reference list

Agarwal, R. (2005). Hypertension and survival in chronic hemodialysis patients-past lessons and future opportunities. Kidney International, 67, 1-13.

Center for Disease Control and Prevention. (2010). National chronic kidney disease fact sheet: General information and national estimates on chronic kidney in the United States, 2010. Atlanta, GA: U.S. Department of Health and Human Services, CDC.

Hughson, M.D., Douglas-Denton, R., Bertram, J.F. & Hoy, W.E. (2006). Hypertension, glomerular number, and birth weight in African Americans and white subjects in the southeastern United States. Kidney International, 69, 671-678.

Lea, J. et al. (2005). The relationship between magnitude of protenuria reduction and risk of end-stage renal disease: Results of the African American study of kidney disease and hypertension. Arch Intern Med., 165 (8), 947-53.

O’Rourke, M.F. & Safar, M.E. (2005). Relationship between aortic stiffening and microvascular disease in brain and kidney: Cause and logic of therapy. Hypertension, 46, 200-204.

The Immortal Life Of Henrietta Lacks Book Review

Introduction

Nursing is a field that requires practitioners to apply outlined ethical guidelines and focus on the best ways to transform their patients’ experiences. In the book The Immortal Life of Henrietta Lacks, readers can acquire numerous ideas regarding the concepts of informed consent and confidentiality and their relevance in medical practice. This reflection relies on the issues outlined in this text to explain the true meaning of ethics in health and medicine.

Reflection

Ethics is a field that guides people to act in a moral manner and engage in actions that could become universal laws. The American Nursing Association (ANA) provides a code of practice which all practitioners need to follow without negotiation. They should offer personalized services, but the demands of their patients first, and avoid malpractices that have the potential to undermine the effectiveness of the profession (Noroozi et al., 2018). Practitioners who promote such aspects will become competent caregivers in their respective fields.

The unlikely story of Henrietta Lacks is worth analyzing since it describes how scientists and medical practitioners used her cells without the permission of any family member. Such decisions would later lead to critical advances in the field of medicine, such as human cloning and vitro fertilization. Unfortunately, Lacks’ immortality remains controversial since the researchers obtained and preserved her genes and cells without her consent. Additionally, her children and husband would also become victims of continuous scientific invitations without getting their approval (American Nurses Association, 2015). This malpractice would also expose some of the unethical experimentations that many scientists conducted on African Americans.

From this understanding, it is agreeable that the decisions some of the researchers made in the studied story would eventually have significant consequences. The first implication is that the move to clone human cells is unacceptable and against the ethical principles of nursing. For example, the act is unjust and capable of affecting the overall experience of the victim and his or her relatives. The second one is that the use of human subjects in undisclosed research studies is unethical and against the consent of the targeted individuals (Skloot, 2011). These aspects explain why Henrietta’s daughter was devastated after receiving the news of her mother’s cells. She became concerned since she was not sure how she might have died and the challenges went through.

The insights gained from the text offer convincing reasons for pursuing ethical practices in all medical fields. The ANA codes are capable of compelling individuals who are in the nursing profession to act ethically, promote patient autonomy, and engage in advocacy. Such professionals will remain committed to the individuals they serve, address emerging problems, and seek informed consent (Biros, 2018). These experts need to remain committed to the community they serve if they are to record positive results. Nurses and clinicians who consider the information obtained from the studied book will find a compelling reason to make ethics their primary guiding principle for their respective decisions.

Conclusion

The above reflection has explained why medical practitioners should follow the outlined ethical values. The insights gained from the identified text should encourage researchers in the field of medicine to do what is right and avoid every possible consequence. Such a practice will transform the image of the healthcare sector and eventually support the delivery of high-quality, culturally competent, and personalized medical services.

References

American Nurses Association. (2015). Code of ethics with interpretative statements. Silver Spring.

Biros, M. (2018). Capacity, vulnerability, and informed consent for research. The Journal of Law, Medicine & Ethics, 46(1), 72-78. Web.

Noroozi, M., Zahedi, L., Bathaei, F. S., & Salari, P. (2018). Challenges of confidentiality in clinical settings: Compilation of an ethical guideline. Iranian Journal of Public Health, 47(6), 875-883. Web.

Skloot, R. (2011). The immortal life of Henrietta Lacks. Broadway Books.