Workplace Reengineering, Reorganization, and Redesign From Nursing Management: Principles and Practice

Patricia Stanfill Edens, RN, MS, MBA, FACHE

September 13, 2005

In This Article

Strategies for Success

Managers who are challenged to reengineer, reorganize, or redesign the workplace can be ensured success by incorporating several simple management principles. Establishing the appropriate management tone in the workplace far in advance of any needed intervention is key. Creating a climate conducive to open communication and safety in challenging the status quo is most important. Employees encouraged to share opportunities and issues in advance of collapse can protect the organization from the need for redesign or reengineering. A simple, timely comment from an employee that the patients do not seem happy with the registration process can mitigate major patient dissatisfaction. Correcting small issues before they metastasize is the best strategy. It is natural for change to occur, whether expected or unexpected. Change can only surprise you if you do not expect it (Johnson, 1998). By allowing employees a safe place to verbalize their thoughts, change becomes a natural evolution rather than an unexpected crisis.

A coaching style of management is another success strategy for the manager. Think of the legendary football coaches who inspired their teams to greatness, and draw from their example. You will succeed in inspiring your staff to achievements far greater than if you just manage by mandate. Encourage a shared governance model where staff take increasing responsibility for their actions, and they become engaged and are more willing to do what it takes to achieve success in their workplace. Educating employees to expectations and providing team-building strategies contribute to success in the workplace. If employees can be rewarded or provided incentives for their actions, it reinforces the importance that the organization places on staff participation. A simple question of "Here is where we are; where would we like to be?" may be all it takes to achieve success when those closest to the issue drive the solution. As nurse managers take on greater span of control, it is imperative that staff become self-directed and motivated. Operational excellence must be driven bottom up, not top down. Wise managers know they are only as effective as their weakest employee. Coach employees to their highest level of performance, and managerial success will be enhanced.

Creating a climate for innovation is another management practice that will encourage success. "An agile company turns out innovative products and services and anticipates disruptive events . . . rather than reacting when it may already be too late" (Nohria, Joyce, & Roberson, 2003, p. 49). Encouraging proactive development of services and strategies by staff based on knowledge of the healthcare environment only will invigorate the organization. The organization that protects the status quo ultimately will fail in its mission to provide quality patient care. The care provided five years ago in health care is outdated. Without encouraging innovation, the manager will be guilty of delivering less than optimum care.

Managers must develop a skill set that will serve them as they continue their management careers. Many of the topics in this chapter require management knowledge, not clinical expertise. Because many managers in the healthcare setting come from a clinical background, management knowledge may be lacking. As we do our patients a disservice if we are not clinically prepared, we do our employees and organization an equal disservice if we lack skills necessary for success. Formal courses such as an MBA program, continuing education, and self-study will provide additional education to the manager and will contribute to personal growth and success.

Recognizing that change is inevitable, the manager can develop the skills needed to manage it, encourage staff to communicate in advance of chaos, and, ultimately, be able to lead and intervene in workplace reengineering, reorganization, or redesign. The knowledge that no situation is unmanageable is reassuring as managers are asked to do more with less, manage multiple departments, and are expected to deliver quality care and retain a strong, viable workforce. With a team effort led by knowledgeable, capable, and competent leadership, the workplace can survive and prosper despite any challenge.

Excerpted from Nursing Management - Principles and Practice, edited by Mary Magee Gullatte, RN, MN, ANP, AOCN, FAAMA. Excerpted by permission of The Oncology Nursing Society. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher. For more information about The Oncology Nursing Society or to purchase this book, please visit:

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