Organizational culture assessment before and after implementing patient-focused care.

Administration of a baseline multidisciplinary cultural assessment survey prior to any change effort (to evaluate as well as redesign units) is essential to success in any work redesign effort. Training efforts can then be directed toward effecting the desired changes in perceived norms and values. All involved groups should be surveyed using the same survey tool to elicit potential differences in perceptions of values among various work groups. Proactive values which are seen as predictive of greater change readiness include high teamwork (clan) values, flexibility, as shown by comfort with adhocracy, and recognition of external or market driven realities. Values and norms which are found to be problematic in change efforts include: a reactive orientation marked by strong hierarchical values, a command and control orientation, and strong reliance on rules. Predictors of success include a history of shared governance, while greater difficulties could be anticipated in both unionized and academic health care settings.

Mercy Healthcare's CARE 2000: an evolution in progress.

In a learning environment of shared governance, continuous quality improvement, and redesign principle application, disciplines of Mercy Healthcare San Diego produced their patient care delivery redesign model, Creative Actions Reflecting Excellence. Nurses, pharmacists, medical technologists, respiratory care practitioners, physicians, educators, managers, and many other professional and technical partners converted change and transition into opportunities. As disciplines understood and appreciated each other's unique and shared contributions, quality of care, stakeholder satisfaction, and process efficiencies increased.

A cost-benefit analysis of shared governance.

Shared governance is one of several strategies promoted by and to nurse executives as critical to retention of professional nurses and important in maintaining quality of care. Thus far, few studies have examined the various financial aspects of this type of decision-making structure. This article identifies a framework for cost analysis and reports the cost-benefit relationship of implementing a shared governance model over a 5-year period.

Courtesy in caring. The patient as customer.

If you were paying $500 a night for a hotel room,. would you be happy if you were told you would be sharing it with a stranger? While such a question cannot be literally asked about a hospital experience, metaphorically it can be--and is--asked every time a patient enters a hospital. The idea of patient-as-consumer is not longer just another trendy concept but an integral part of the way many hospitals do business, and it's the hospital manager's responsibility to ensure the customer's satisfaction.