With the foundation and commitment of our spiritual heritage and values, our mission is to promote the health and well-being of the people in the communities we serve through a comprehensive continuum of services in collaboration with the partners who share the same vision and values. The hospital’s mission statement is printed on their business cards, communicated daily, and frequently referred to as the data source for procedural decision making. The lack of detailed polices and procedures to support a common framework for applying the mission statement is endangering the hospital’s stakeholder and customer relationships and weakening the business.
There is no single recipe for success in business or for chocolate cake. In baking the terms tad, sprinkle, and pinch are open to a wide range of interpretation. The same ambiguity exists for the phrases “spiritual heritage and values”, “health and well-being” and “same vision and values” which are included in the Faith Community Hospital mission statement. According to Browne and Keeley (2000, p. 36), “Our language is highly complex. If each word or phrase had only one potential meaning about which we agreed, effective communication would be more likely. However, most words and phrases have more than one meaning.” “Definitions serve the purpose of limiting ambiguity. They generally set sharp boundaries so we know what we are talking about and what we aren’t” (Lebensold, n.d., chap. 6).
Without a common understanding, interpretation of the mission statement has become fragmented. As a consequence, stakeholders have only a vague idea on how to apply the hospital’s mission to their daily job tasks and responsibilities. Decisions, such as initiating Do Not Resituate (DNR) directives, are made based on individual values, beliefs, attitudes, and expectations. Values are beliefs or attitudes about what is good, right, desirable, worthwhile, etc. The value system is the way one organizes, ranks, prioritizes and makes decisions based on these values. The values provide the foundation from which one makes their personal and professional judgments and choices. They are beliefs about what is important in life. (Ursey, 2002 Para 1)
The CEO stated “Faith Community members and partners believe in the hospital’s mission statement and try hard to live by it.” However, among the stakeholder group there are various interpretations of the hospital’s core values and mission. “Those values which one consistently ranks higher than others are called core values” (Ursey, 2002, Para 5). Decisions must be made when there is a conflict of medical obligations, religious values, and legal responsibilities. Influencing these decisions are individual perceptions of the right thing to do.
“Perception is interpretation and organization of stimuli. Perception is influenced by an assortment of factors, including the intensity of the stimulus, the activities preceding stimulation, past experience, and the motivation and emotional state of the individual” (Perception, 2002, Para 1). “Ranking or prioritizing must be established since this is one of the best ways to help decide what the hospital’s primary core value is. Thus assist stakeholders in making moral judgments” (Ursey, 2002, Para 5). Creating and communicating the approved interpretation and ranking of the hospital’s core values and mission will provide the common framework for establishing decision making guidelines.
“When organizations have extrinsic problems, the cause can be from a lack of skills and knowledge, inappropriate or misunderstood procedures or a lack of data for good decision making judgment” (Andrews, 1996 Para 9). One missing aspect of strategic business planning at Faith Community Hospital is the implementation phase. To implement the hospital’s vision; clear concise written policies are essential. Specific written procedures on how to manage job responsibilities in accordance with the written policies and the mission statement will provide the data for good decision making.
The CEO of Faith Community Hospital identified the stakeholders who “share the same vision and values” as the Board of Directors of the Faith Foundation, hospital staff, patients, and their families. The exclusion of Child Protective Services, insurance companies and their regulators as key stakeholders has placed the hospital in a precarious legal and financial predicament. Child Protective Services is in the process of taking custody of a child in the Neo-Natal Ward and has threatened to sue the hospital. The hospital’s actions were in accordance with the parents’ wishes yet Child Protective Services is threatening to sue the hospital for, as they allege, failure to provide services.
The most prominent systems of beliefs tend to be those associated with formal religions; however, any system of belief in which the interpretation of stories affects people’s behavior — a system of superstitions, for example — can be a living, contributing component of a given society’s culture. (Values and beliefs as components of culture, n.d.)
Child Care Services relied on a different set of behavioral norms, based on a different value of beliefs, moral convictions, and legal obligations to make the decision about appropriate medical care. This public conflict of religious beliefs, moral convictions and values, medical and legal responsibilities has tarnished the hospital’s reputation in the community. Additional threats of lawsuits and allegations of mistreatment will cause irreparable harm to the Faith Community Hospital brand. Building a brand is a long process and news headlines touting alleged medical errors and lawsuits negatively impact the Faith Community Hospital brand. A strong brand is essential to profits. While the hospital is a not for profit organization, a strong brand is essential to reducing operating costs without effecting the quality of medical care.
The CEO’s side-bar conversation regarding insurance companies and regulators clearly demonstrate his frustration and his distain of these stakeholders. “If we had more time and stamina, I could also tell you about the so called especially wonderful collaborations with the insurance companies and regulators. Who gets covered, how much and when we get paid, seem to be totally out of our hands at times.” The CEO’s perception of these business partners indubitably is reflected in his actions and words. Leaders lead by example and the CEO’s judgment of these groups as the enemy instead of valued business partners will filter through the organization as acceptable behavior.
“Successful business owners know or at least have an idea of what their customers, employees and stakeholders want or expect from them. This type of anticipation can be helpful in building satisfaction and loyalty” (The business plan – road map to success 2001, Para 4). It certainly is a good strategy to invite groups with vested interests in the hospital to participate as partners in the problem solving process instead of as opponents in a lawsuit.
“It becomes obvious that problems such as unclear role expectations and poor communication are rooted in defective organization-wide processes” (Andrews, 1996). The recommended corrective courses of action include translating the mission statement into clear concise written policies and procedures. Specifically state the parameters of latitude for predictable medical, religious, and legal conflict scenarios. These policies and procedures will provide the structure for shared boundaries and a common frame of reference for effective decision making.
Include government agencies and insurance companies as key stakeholders and obtain their support as partners for the new procedures. Ensuring that all appropriate parties are involved in and support the procedures outlined for decision making will reduce the hospital’s vulnerability to lawsuits such as the one pending by Protective Child Services. Inclusion of these previously excluded stakeholders will add specialized subject matter knowledge to the problem solving process.
Obtaining consensus among numerous business partners with conflicting priorities can be a challenging endeavor. The task will be even more daunting with the CEO’s current perceptions as to the value of these stakeholders. According to Barkow (2001 Para 5), “Knowing who your stakeholders are, what they think and how they react to problems are some of the key ingredients to a solid business plan.” Recommendations include using past communication failures as a tool to build new successes.
Communication of the new processes and frequent follow-up to ensure adherence to the processes will be required to initiate and sustain a shift in the organizational culture. Conducting periodic staff calibration sessions and analyzing past conflict scenarios and decisions are two methods of validating alignment to the hospital’s goals. Additional recommendations include setting up a formal plan of periodic stakeholder review of the established processes. These processes will be a working strategy that will need to change as the business needs and cultural norms change. Document procedures for changing the current policies to ensure processes will not become outdated and ineffective.
Thus, with the mission statement, values, and processes written, clearly defined, inter-linked and consistent with each other, the hospital’s brand will be revitalized, medical services will be rendered in a consistent manner, and operating costs will be reduced. “New communication systems, improved process procedures, role clarity and enhanced skill and knowledge can turn Faith Community Hospital’s average organization into one that is high-performing” (Andrews, 1996, Para 11).
Andrews, A. (1996). Choose the right recipe for success. Retrieved September 22, 2002, from The Reengineering Resource Center Web Site: http://www.reengineering.com/articles/jun96/nutsbolt.htm
Barkow, T. (2001, February 23). What’s a business plan? Retrieved September 22, 2001, from http://www.webreview.com/soapbox/2001/02_23_01.shtml
Browne, M. N., & Keeley, S. M. (2000). Critical thinking: Asking the right questions (2nd ed.). Boston, MA: Pearson Custom Publishing.