I clearly notice that there is a problem with the structure of hierarchy. In this case, she is supposed to report to multiple leaders and decision makers in multiple divisions who might be having a different view to the same issue. Over time, this could have complicated the situation where the technical director might have been left confused on the reaction of different individuals and might be trying to work out on the way to present the issue, thus resulting in complex communication which might have been perceived as lack of transparency adding to the challenges.
The solution for this can only be
1) any issue that needs involvement of multiple stake holders for decision making, may be taken up with all of them together and brainstorming along with the technical director thus making it a flat organisation where there can be multiple reporting structures and authorities.
2) in case where the above is not possible, the reporting structure must be changed to the technical director reporting and taking orders and advises from only one designated leader clearly defining the hierarchy.
The other challenge presented above is of the negative interactions with the peers.
When such feedback is received, it becomes very important that the leaders understand the premise of such a feedback and the holistic picture than confining to the keyhole view as this is a totally subjective condition where different people react differently for the same situation/communication.
The technical director may be made aware of the peer feedback giving her the opportunity to correct her approach wherever needed as she is a very valuable asset for the project struggling to make her way through the complex environment of the organisation with multiple reporting authorities and project deadlines.
Any Change management process must leverage against constant, continuous, efficient and fool proof feedback mechanism along with continuous audit.
The feedback format must be very simple and easily understood, less subjective, more objective oriented but yet shouldn’t limit the expression of the respondent. Further, anonymous feedback always encourages the participants to provide honest inputs. It is also important that the leaders understand the prioritisation of the inputs from the feedback mechanism to be able to come out with holistic long term and short term solutions to the issues that keep cropping up . Leaders must be constantly trained on how they seek and receive feedback making sure the feedback in no situation is taken as a tool to assess the respondents performance at work.
The feedback mechanism though is a very important tool for inclusive management but is never the right measuring scale for rating the efficacy of the change management practice. The efficiency in the implementation of change should be continuously monitored through audits defining clear and object oriented parameters and must not be graded limiting to feedback alone.
The key leverages of the aforesaid hospital are the only tertiary care hospital in the area with JCI accreditation. In such a scenario, the hospital would contemplate on increasing the volumes and increasing the value. Large volumes usually come at low cost . As there is no probability of compromise in cost structure, we should work on increasing value. Such value can be achieved through high ticket cases and complex procedures as this hospital is with high quality infrastructure and can attract highly experienced doctors to perform these procedures in the hospitals. Once the positive patient outcomes for highly complex cases are established, the ripple effect would inturn increase the volumes for other tertiary and secondary care procedures based on the perceived value – A hospital which can handle the highly complex case very efficiently has experts to be able to tend to all other major illnesses.
Creating and sustaining Organisation culture is indeed a huge challenge with the only effective solution being continuous training to all the staff starting from the board room to the last employee in the hierarchy. Most of the training provided gets confined to the HODs and ensuring that it percolates all the way down should be given equal importance. Further, we should also ensure that the actual intended and expected culture does not get lost in the interpretation and the training of the trainers. To overcome this, the organisation should invest in generating uniform content and curriculum . Adequate care should be taken while generating the content as different levels in the hierarchy have different levels of understanding.
Further, the branding initiatives of posters and banners in all the visible surroundings that portray the organisation culture work as constant reminders ensuring that the culture is instilled as an integral part of the organisation behaviour.
Our country ( India) has a challenge of multiple languages , cultures and health risks changing for every 100 kms. So, it becomes imperative for us that we communicate to the low literacy group / illiterates in their vernacular language. Audio visual communication tools have proven to be more effective than pamphlets or brochures. Engaging their local healthcare providers or training some local volunteers to engage in healthcare education ( other than doctors ) for the job will help them connect to their educators more effectively than expecting them to struggle through the Doctor – Patient chasm which might lower the possibility of expressing their challenges and continuously seeking education and solutions.
Pre-printing prescriptions though is a conceivable solution , still leaves the challenge unaddressed as Indian drugs are prescribed / dispensed on various trade names than their proper drug names and each doctor has their preferred choice of drugs ( by their trade name) making it quite complex for implementation in a multi-speciality and huge set up with more than 100 doctors of various specialities attending to the out patients every day.
As mentioned in the submission, we are seeking solutions in the Out Patient scenario. The route of drug administration with period and interval is mentioned and the patients are educated accordingly.
Our problem area is more of a dispensing error than administration error. The double verification is an effective and tried solution , but is not effective enough when huge volumes of patients crowd at the pharmacy during peak hours.
As mentioned in the submission, we are seeking solutions in the out patient scenario. In this case, we do not dispense high risk medication or narcotics to out patients. The route of drug administration with period and interval is mentioned and the patients are educated accordingly. Our problem area is more of a dispensing error than administration error. The double verification is an effective and tried solution , but is not effective enough when huge volumes of patients crowd at the pharmacy during peak hours.
It is imperative that we come to terms with the fact that the current day hospital function is not limited to care givers alone. Stretching the care givers to do a multitude of non- care giving jobs would ultimately lead to a burn out. As there is always a dearth of qualified and skilled resources in healthcare, the optimal utilisation of their skill set , not pushing them to deliver to non- domain activities ( with a different skill set unrelated to their core domain ) that consumes their care giving time is of utmost priority. We have to ensure that the human resources of a hospital are clearly defined based on their core skill set followed by optimal recruitment and continuous training and utilisation. Such continual training and enhancement of domain related skill set has to be done both for clinical and non- clinical resources in the hospital thus improving the efficiency of delivery.