Whitfield Nursing Care

Whitfield Nursing Care is an organization facing massive change.  The company was founded in 1972 with just two nursing homes in Phoenix, Arizona.  The company was very successful, and throughout the 1980s, it continued to turn a consistent profit while slowly adding 30 more locations (some through acquisition and some built by the company).  This low-profile approach changed in 1993 when Robert Queen, a venture capitalist, decided to make a major investment in expanding Whitfield in return for a portion of its profits.  As a result of this investment, Whitfield was operating 180 nursing homes by 2000. 

Currently, the firm has 220 facilities in the south-western United States, with an average of 115 beds per facility and a total of nearly 30,000 employees.  In addition to health care facilities, it also provides skilled in-home nursing care.  Whitfield is viewed as one of the best care facilities in the region and has won numerous awards for its achievement for high quality.  As members of the Baby Boom generation continue to age, the need for skilled care will only increase.  Whitfield wants to make sure that it is in a good position to meet this growing need so there is pressure for growth in order to meet this demand.  Besides this challenge, the nursing home industry has come under increasing government scrutiny following investigations that turned up widespread patient abuse and billing fraud.  Whitfield has always had outstanding patient care and no substantiated claim of abuse or neglect has ever been made, but the need for increased documentation will still affect the company.  In addition, as the federal government tries to trim Medicare expenses, Whitfield may face a reduction in funding. 

As growth in the company has continued, Whitfield has remained committed to providing dignity and health to all residents in its facilities.  The board of directors wants to see renewed commitment to the firm's mission and core values, but is aware that there are employee concerns that need to be addressed.  Shift leader Maxine Smith has been with Whitfield for 15 years.  "Now that the government keeps a closer eye on our staffing levels, I've seen management do what it can to keep positions filled, and I don't always agree with who is hired.  Some of the basic job skills can be taught, sure, but how to care for our patients---a lot of these new kids just don't pick up on that." A nurse's aide, Bobby Fenton, said "The problem isn't with the staff---it's the company's focus on filling the beds.  When I started here, Whitfield's reputation was still about service.  Now it's about numbers.  No one is intentionally negligent---there are just too many patients to see."

A recent college graduate with a Bachelor's degree in psychology, Dan Merton is more stressed than he expected to be.  "These aren't the sweet grannies that you see in the movies.  Our patients are demanding.  They complain about everything, even about being called patients, probably because most of them think they shouldn't be here in the first place.  A lots of times, their gripes amount to nothing, but we have to log them in anyway."  Carmen Jones has been with Whitfield for almost a year and is already considering the idea of finding a new job.  "I knew there were going to be physical parts to this job and I thought I'd be able to handle that.  It's not like I was looking for a desk job, you know?  I go home after every shift with aches all over---my back, my arms, my legs.  I've never had to take so much time off from a job because I hurt.  Then when I come back, I feel like the rest of the staff thinks I'm weak." Nancy Wilson says "I started working here right out of high school because it was one of the best paying jobs I could get.  I had no idea what I was getting myself into.  Now, I really like the job.  Next year, I'm going to start taking night classes so that I can move into another position.  Some of the staff just think of this as any other job.  They don't see the patients as people, more like inventory.  If they want to work with inventory, they should get a job in retail." 

Last month, the company's Human Resources department pulled the following information from its records at the request of the board of directors.  The numbers provide some quantitative support for the concerns voiced by the staff.  Injuries to staff occur mostly because of back strain from lifting patients.  Patient incidents reflect injuries due to slips, falls, medication errors, or other accidents.  Certified absences are days off from work due to medically related illnesses or injuries.  Other absences are days missed that are not due to illnesses or injuries; these are excused absences (unexcused absences are grounds for immediate termination).

The above information was provided to the board of directors.  While they are happy with the company's growth, the board felt it was time for a change in leadership and decided to replace the current CEO who has been in that role for the past 8 years.  A search for a new CEO is underway.  The board also wanted to gather employee input and use this to create a change message that everyone can support.  The Human Resources department offered to conduct focus groups, asking employees to describe some of their concerns and their suggestions for the future.  While the focus groups generated lots of suggestions, not all of them were in the same direction. 

Many suggestions concerned schedule flexibility.  One common comment was this: "Most of the stress on this job comes because we can't take time off when we need it.  The LPNs (licensed nurse practitioners) who do much of the care and the orderlies can't take time off when they need to, but a lot of them are single parents or primary caregivers for their own children.  When they have to leave for child care responsibilities, the work suffers and there is no contingency plan to smooth things over.  Everyone else who is left on the job has to work extra hard to make up for the missing person.  The person who takes time off feels guilty and there can be fights over taking time off.  If we had some way of covering those emergency absences, we'd all be a lot happier and I think that the care would be a lot better."  Other suggestions proposed a better method for communicating information across shifts.  Most of the documentation for shift work is done in large binders kept at the central nursing station in each care area.  When the new shift begins, staff members say that they don't have time to check on what happened in the previous shift.  Some younger caregivers would like to have a method that lets them document patient outcomes electronically because they type faster than they can write.  The older caregivers are more committed to the paper-based process, in part because they think that switching systems would require a lot of work.  Government regulations on health care reporting require that any documentation be made in a form that cannot be altered after the fact, to prevent covering up abuse so specialized software systems must be used for electronic documentation.

Finally, the nursing care staff believes its perspectives on patient care are seldom given an appropriate hearing.  "We're the ones who are with the patients most of the time, but when it comes to doing this the right way, our point of view gets lost.  We really could save a lot of money by eliminating some of these unnecessary routines and programs but it is something management always just says it will consider."  Staff members seem to want some way to provide suggestions for improvement but it is not clear what method they would prefer.

Questions

Please answer the following questions.  Your grade will be based heavily on how well you use course information/topics, as well as examples of information from the case, to support your answers.  This case deals primarily with issues of diversity/generational differences, motivation, organizational culture, job stress, emotional labor, leadership, empowerment, and organizational change but feel free to utilize other concepts if you see them as relevant.Please make sure that you are thoroughly answering each of the questions by using course concepts and examples for the case to support your answers.

1. Analyze the data on employee injuries, incidents, absences, and turnover.  What does this data suggest to you?  Is there reason for concern about the company's direction?  If so, what concerns you the most?

2. What are the major sources of job stress at Whitfield?  Given their comments, do you think that employees are also experiencing emotional labor or burnout?  Why?

3. What changes do you believe need to be made in order to address any concerns about the data provided in #1 and the sources of job stress in #2?  What do you think about the Human Resources department's efforts to use focus groups as a means of getting suggestions for change?  Was this a good idea?  Do you think any of the suggestions made are valid? 

4. How do you recommend any of the above changes be implemented?Give some type of timeline for this and who would be involved.  What kinds of resistance, if any, would you expect to see at Whitfield?  Do you see any potential conflicts based on generational groups?  How would you try to minimize this?

5. What type of organizational culture does Whitfield Nursing Care currently appear to have?  Does it seem appropriate for the company, given their industry and goals as a firm?  Do you believe that a different type of organizational culture would be more appropriate?  If so, why?  How would your recommended changes impact the corporate culture, if at all? 

6. Given the board of directors' desire to re-energize the workforce, what type of leadership should the board be looking for in the new CEO?  Why?  What leader behaviors do you think nursing home directors and nurse supervisors should demonstrate?  Why?

7. (Optional).  Please add any other thoughts you have on the case that were not addressed in the above questions.