MHAFP 5040 Capella University Improving TUFTS NEMC Case Presentation Develop a 15-minute presentation, with slides and recorded audio, outlining the actions you believe Ellen Zane must take to lead Tufts Hospital to the next level of sustainability in a highly competitive health care marketplace.Note: The assessments in this course build upon the work you have completed in the previous assessments. Therefore, complete the assessments in the order in which they are presented.SHOW LESSThe selection and use of appropriate measurement tools and control processes is important. They enable health care leaders to objectively quantify and evaluate outcomes.This assessment provides an opportunity for you to assess the outcomes of a change initiative and recommend steps toward sustainable change in a highly competitive health care marketplace.By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 4: Process Management and Organizational Design: Benchmark good processes and practices.
Propose best practices to improve both clinical and nonclinical outcomes for an organization.
Determine the cost and revenue implications for the organization of proposed best practices.
Analyze customer service and satisfaction drivers in an organization.
Competency 5: Performance Measurement: Use evidence-based approaches to support community wellness.
Determine how to assess organizational success and the timeliness, effectiveness, and efficiency of services after a change is implemented.
Select specific measurements for assessing post-change organizational success.
Competency 6: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards.
Present findings and conclusions clearly and coherently in an engaging an effective manner.
Support main points, arguments, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.
Competency Map
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Resources
REQUIRED RESOURCES
The following resource is required to complete the assessment.
Ingols, C. & Brem, L. (2016). Case study 5 Ellen ZaneLeading change at Tufts/NEMC [PDF]. In Cawsey, T. F., Deszca, G., & Ingols, C. Organizational change: An action-oriented toolkit (3rd ed.), (pp. 448479).
This case study is the basis for this assessment.
SUGGESTED RESOURCES
The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MHA-FP5040 Health Administration Change Leadership Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.
Organizational Change
The following resources may be of use to you in outlining the actions that you believe will lead the organization to the next level of sustainability in a highly competitive health care marketplace.
Kotter, J. P. (2007). Leading change: Why transformation efforts fail. Accountancy SA, 1929.
Identifies eight key errors made by organizations that impede transformational change. This article is a seminal work. John P. Kotter is an expert and thought leader in change leadership.
Kotter, J. P. (2014). Capturing the opportunities and avoiding the threats of rapid change. Leader to Leader, 2014(74), 3237.
Kotter looks at the life cycle or organizations and proposes a new way of leading organizations that blends the best aspects of a start-up organization with that of a mature system of organizational leadership and management to take advantage of todays pace of rapid change, complexity, and disruption.
Stonehouse, D. (2013). Resistance to change: The organisation dimension. British Journal of Healthcare Assistants, 7(3), 150151.
Addresses the issue of resistance to change encountered within an organization by those closest to patient care, who are best positioned to recognize the need for improvements and change.
Challenges at Tufts/NEMC | Transcript.
Timeline of Events at Tufts/NEMC | Transcript.
Rating the Organization’s Readiness to Change | Transcript.
A Balanced Scorecard for Change | Transcript.
A Summary Checklist for Change.
Effective Presentations
The following resources will help you create and deliver more effective presentations.
Capella University Library: PowerPoint Presentations.
Links to PowerPoint and other presentation software resources.
Conquering Death by PowerPoint: The Seven Rules of Proper Visual Design | Transcript.
A video primer on presentation design.
Approximate run time for all 10 video segments: 45:00.
Creating a Presentation: A Guide to Writing and Speaking | Transcript.
Covers the primary areas involved in creating effective audiovisual presentations. You can return to this resource throughout the process of creating your presentation to view the tutorial appropriate for you at each stage.
Microsoft. (2016). Record a slide show with narration and slide timings. Retrieved from https://support.office.com/en-us/article/Record-a-…
A tutorial on recording slide narration and setting slide timing.
Writing Resources
You are encouraged to explore the following writing resources. You can use them to improve your writing skills and as source materials for seeking answers to specific questions.
APA Module.
Academic Honesty & APA Style and Formatting.
Capella Resources
Using Kaltura.
Disability Services.
Additional Resources for Further Exploration
Cawsey, T. F., Deszca, G., & Ingols, C. (2016). Organizational change: An action-oriented toolkit (3rd ed.). Thousand Oaks, CA: Sage. Available from the bookstore.
Chapter 10, Measuring Change: Designing Effective Control Systems, pages 339372.
Assessment Instructions
Note: This assessment includes a synthesis of your analyses from the previous two assessments. Therefore, complete the assessments in this course in the order in which they are presented.
PREPARATION
Review the case study, Case Study 5: Ellen ZaneLeading change at Tufts/NEMC, linked in the resources.Review the balanced scorecard approach.Note: Remember that you can submit allor a portion ofyour draft presentation to Smarthinking for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 2448 hours for receiving feedback.
Presentation Tools
You may use Microsoft PowerPoint or any other suitable presentation software to create your slides. If you elect to use an application other than PowerPoint, check with your instructor to avoid potential file compatibility issues.Use the speaker’s notes section of each slide to develop your talking points and cite your sources, as appropriate. If you need help designing your presentation, you are encouraged to review the various presentation resources provided for this assessment. These resources will help you to design an effective presentation, whether you choose to use PowerPoint or other presentation design software.Record a voiceover track for your presentation, using Kaltura Media or other technology of your choice.
If using Kaltura Media, refer to the Using Kaltura tutorial for directions on recording and uploading your video in the courseroom.
Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact Disability Services to request accommodations.
REQUIREMENTS
By summer 2006, Ellen Zane had brought about a dramatic turnaround of one of America’s oldest hospitals through meeting a series of efficiency goals, recruiting doctors, and negotiating with Massachusetts’s health insurance providers. Zane must now take the hospital to the next level of sustainability in a highly competitive health care marketplace. How should she do this?
Benchmarking and Analysis
Note: The requirements outlined below correspond to the first five grading criteria in the scoring guide. Be sure that your presentation addresses each point, at a minimum. You may also want to read the Case Study Presentation Scoring Guide to better understand how each criterion will be assessed. Be sure to note the requirements in the Distinguished column.
Propose best practices to improve both clinical and nonclinical outcomes for the organization.
Conduct the necessary benchmarking research.
Why will your proposed best practices yield the desired improvements? What evidence do you have?
Determine the cost and revenue implications for the organization of proposed best practices.
Apply the cost and revenue implications to the financial facet of the balanced scorecard.
Analyze the customer service and satisfaction drivers present in the case study.
Apply those drivers to the customer facet of the balanced scorecard.
Consider how these drivers influence assessment criteria.
Determine how to assess organizational success and the timeliness, effectiveness, and efficiency of services after the change was implemented.
Compare various assessment methodologies.
What evidence supports your assertions and conclusions?
Select specific measurements for assessing post-change organizational success.
What is your rationale for selecting these measures?
How can these measures be used to sustain and further improve practice?
Presentation Development
Develop a slide presentationnot longer than 15 minutesthat outlines the actions you believe Ellen Zane must take to lead Tufts Hospital to the next level of sustainability in a highly competitive health care marketplace. Combine your benchmarking and analysis information from this assessment, your case study analyses from the previous two assessments, and the feedback you received from your instructor. Your intended audience in this case would be C-level executives and board members.Note: The additional requirements outlined below correspond to the last two grading criteria in the scoring guide. Be sure that your presentation addresses each point, at a minimum. You may also want to read the Case Study Presentation Scoring Guide to better understand how each criterion will be assessed.
Present your findings and conclusions clearly and coherently in an engaging an effective manner. Proofread your slides to minimize errors that could distract the audience and make it more difficult to focus on the substance of your presentation.
Does the design and flow of your presentation reflect adherence to the basic principles of effective presentations?
What are the anticipated needs and concerns of your audience?
What questions or alternative points of view might you expect from your audience? How will you respond?
Support main points, arguments, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.
Is your supporting evidence clear and explicit?
How or why does particular evidence support a claim?
Will your prospective audience see the connection? Overview
Develop a 15-minute presentation, with slides and recorded audio, outlining the
actions you believe Ellen Zane must take to lead Tufts Hospital to the next level
of sustainability in a highly competitive health care marketplace.
Note: The assessments in this course build upon the work you have completed in
the previous assessments. Therefore, complete the assessments in the order in
which they are presented.
The selection and use of appropriate measurement tools and control processes is
important. They enable health care leaders to objectively quantify and evaluate
outcomes.
This assessment provides an opportunity for you to assess the outcomes of a change
initiative and recommend steps toward sustainable change in a highly competitive
health care marketplace.
By successfully completing this assessment, you will demonstrate your proficiency
in the following course competencies and assessment criteria:
Competency 4: Process Management and Organizational Design: Benchmark good
processes and practices.
Propose best practices to improve both clinical and nonclinical outcomes for
an organization.
Determine the cost and revenue implications for the organization of proposed
best practices.
Analyze customer service and satisfaction drivers in an organization.
Competency 5: Performance Measurement: Use evidence-based approaches to
support community wellness.
Determine how to assess organizational success and the timeliness,
effectiveness, and efficiency of services after a change is implemented.
Select specific measurements for assessing post-change organizational
success.
Competency 6: Communicate effectively with diverse audiences, in an appropriate
form and style, consistent with applicable organizational, professional, and scholarly
standards.
Present findings and conclusions clearly and coherently in an engaging an
effective manner.
Support main points, arguments, and conclusions with relevant and credible
evidence, correctly formatting citations and references using APA style.
Assignment Instruction
Note: This assessment includes a synthesis of your analyses from the previous
two assessments. Therefore, complete the assessments in this course in the
order in which they are presented.
Preparation
Review the case study, Case Study 5: Ellen ZaneLeading change at
Tufts/NEMC, linked in the resources.
Review the balanced scorecard approach.
Note: Remember that you can submit allor a portion ofyour draft
presentation to Smarthinking for feedback, before you submit the final version for
this assessment. If you plan on using this free service, be mindful of the
turnaround time of 2448 hours for receiving feedback.
Presentation Tools
You may use Microsoft PowerPoint or any other suitable presentation software to
create your slides. If you elect to use an application other than PowerPoint,
check with your instructor to avoid potential file compatibility issues.
Use the speaker’s notes section of each slide to develop your talking points and
cite your sources, as appropriate. If you need help designing your presentation,
you are encouraged to review the various presentation resources provided for
this assessment. These resources will help you to design an effective
presentation, whether you choose to use PowerPoint or other presentation
design software.
Record a voiceover track for your presentation, using Kaltura Media, Adobe
Connect, or other technology of your choice.
If using Kaltura Media, refer to the Using Kaltura tutorial for directions on recording
and uploading your video in the courseroom.
If using Adobe Connect, refer to the instructions and tutorials available from the
Using Adobe Connect support page.
Note: If you require the use of assistive technology or alternative communication
methods to participate in this activity, please contact Disability Services to
request accommodations.
Requirements
By summer 2006, Ellen Zane had brought about a dramatic turnaround of one of
America’s oldest hospitals through meeting a series of efficiency goals, recruiting
doctors, and negotiating with Massachusetts’s health insurance providers. Zane
must now take the hospital to the next level of sustainability in a highly
competitive health care marketplace. How should she do this?
Benchmarking and Analysis
Note: The requirements outlined below correspond to the first five grading criteria
in the scoring guide. Be sure that your presentation addresses each point, at a
minimum. You may also want to read the Case Study Presentation Scoring
Guide to better understand how each criterion will be assessed. Be sure to note
the requirements in the Distinguished column.
Propose best practices to improve both clinical and nonclinical outcomes for the
organization.
Conduct the necessary benchmarking research.
Why will your proposed best practices yield the desired improvements? What
evidence do you have?
Determine the cost and revenue implications for the organization of proposed best
practices.
Apply the cost and revenue implications to the financial facet of the balanced
scorecard.
Analyze the customer service and satisfaction drivers present in the case study.
Apply those drivers to the customer facet of the balanced scorecard.
Consider how these drivers influence assessment criteria.
Determine how to assess organizational success and the timeliness, effectiveness,
and efficiency of services after the change was implemented.
Compare various assessment methodologies.
What evidence supports your assertions and conclusions?
Select specific measurements for assessing post-change organizational success.
What is your rationale for selecting these measures?
How can these measures be used to sustain and further improve practice?
Presentation Development
Develop a slide presentationnot longer than 15 minutesthat outlines the
actions you believe Ellen Zane must take to lead Tufts Hospital to the next level
of sustainability in a highly competitive health care marketplace. Combine your
benchmarking and analysis information from this assessment, your case study
analyses from the previous two assessments, and the feedback you received
from your instructor. Your intended audience in this case would be C-level
executives and board members.
Note: The additional requirements outlined below correspond to the last two
grading criteria in the scoring guide. Be sure that your presentation addresses
each point, at a minimum. You may also want to read the Case Study
Presentation Scoring Guide to better understand how each criterion will be
assessed.
Present your findings and conclusions clearly and coherently in an engaging an
effective manner. Proofread your slides to minimize errors that could distract the
audience and make it more difficult to focus on the substance of your presentation.
Does the design and flow of your presentation reflect adherence to the basic
principles of effective presentations?
What are the anticipated needs and concerns of your audience?
What questions or alternative points of view might you expect from your
audience? How will you respond?
Support main points, arguments, and conclusions with relevant and credible
evidence, correctly formatting citations and references using APA style.
Is your supporting evidence clear and explicit?
How or why does particular evidence support a claim?
Will your prospective audience see the connection?
Running head: LEADING CHANGE AT TUFTS/NEMC
Leading Change at Tufts-NEMC
Judy Foster
Capella University
Health Admin Change Leadership
MHA-FP5040
April, 2020
1
LEADING CHANGE AT TUFTS/NEMC
2
Introduction
Financially TUFTS-NEMC has been struggling, this was due to a write-down in assets,
and the lack of improved efficiency and enhanced revenue cycle. TUFTS-NEMC was $240
million in debt by 1996 and was losing physicians, market share, and hospital acquisitions to
partners and care group. Something had to be done in order for them to maintain stability. They
were taken out of there network by Harvard Pilgrim HC and it almost caused the place to fail
completely. During this time the administrative staff were affected the most, and they needed to
make changes desperately.
Tufts-NEMC Problems
Before Tufts-NEMC merged with Lifespan the company was struggling. The
gains that were being posted were due to write downs in their assets. This didnt include
improved efficiency or enhanced revenue cycle. The benefit the leaders seen for the merger was
needed capital, a chance for them to gain back lost contracts and the potential for more referrals.
Once the merge took place it did not go as planned. Rhode Island regulators objected a lot of the
capital migrating to Boston. When this took place it reduced the amount of money Tufts-NEMC
was to receive from 30 years to 10 years and only to receive $8.7 million yearly. The physicians
had the decision to refer patients based on their personnel preference or relationship.
Lifespan took most of the administrative and support functions away and made them
centralized at Rhode Island. Tufts-NEMC lost their human resources, finance,
purchasing/supply chain, and IT. The anticipated growth acquisitions also failed to take place.
This forces Tufts-NEMC to separate from lifespan at a loss of $12.3 million a year from revenue.
In the end the merge was not successful at all, it almost took Tufts-NEMC down. During the
1990s, Tufts-NEMC had many problems. Patients length of stay were costing the hospital
LEADING CHANGE AT TUFTS/NEMC
3
money and they were unnecessary. The increase of debt, overspending, lack of payments and
higher overall costs. The state also choose to deregulate medicine which meant anything could
happen. Below is shows an outline:
1990s- Medicare and Medicaid reimbursements were less than the cost.
1991-1996- There was a 24% decline in the hospital discharges and average length of stay.
1990s- Massachusetts insurance plans merged creating increasing power in the marketplace.
1991- Hospital deregulation occurred.
1990s 47 acquisitions and mergers, 19 acute care hospital closures, and 10 new major hospital
systems.
During 2005- there was a lack of capacity due to years of merging and downsizing. Pay for
performance gaining in popularity. Difficulty recruiting new doctors and nurses. Increasing bad
debt due to uninsured and underinsured patient population increase.
Needs of the Community
Tufts-NEMC offered the first permanent medical facility in New England. They offered
medical services for the poor, and gained a reputation for innovation. They were able to assign
nurses to patients and they formed a nurse association. Dental, rehabilitation, venereal disease,
lung, food and nutrition, and evening pay clinics were established. Tufts-NEMC was the first full
service, private teaching hospital in Boston. If Tufts-NEMC fail all of needs available services
would be lost and the community would use needed resources. The reduction in CMS payments,
health insurance plan trends and the loss of being part of one of the major insurance plans also
impacted patients being able to come to Tufts for treatment. Tufts-NEMS mission and vision was
to provide care for people at low costs without sustaining losses. If Tufts-NEMC was to begin to
LEADING CHANGE AT TUFTS/NEMC
4
loose physicians and close the community would be losing a great community resource. Hiring a
new leader and separating from the merger may save the hospital. The lack of strategic resources
in TUFTS-NEMC made that organization less valuable for patients in the Boston area.
Five approaches used to heighten awareness of the needed changes
Ellen Zane vision to strategically fix the economic troubles that Tufts-NEMC had
encountered. There are four processes of environmental analysis, scanning, monitoring,
forecasting, and assessing. The scanning primary process scans and identifies many signals and
changes in an environment. It scans for a potential market which competitors compete to gain a
foothold in a new area. Monitoring analyzes potential changes to see if changes in an
environment becomes abrupt. This helps the company and services to analyze and observe trends
in an area. Forecasting, predictions that occur from monitoring trends and changes that occur in
an area. Assessing, determining the time and significance of trends and changes that occurred
within a particular area and environment. This measures the implications from how trends were
followed with scanning, monitoring and forecasting.
You must be aware enough of the business landscape to recognize that a need for change
exists. Selling change requires impeccable timing. This means having the ability to seamlessly
sell change while minimizing disruption. Once you have become aware of the need for change
and your timing was on-point, your ability to sell change now requires you to showcase your
competencies and capabilities to most effectively generate the outcomes you are projecting.
Having the required tenacity, endurance and passion to sell change all the way through to the end
is never easy and could be the ultimate breaking point to your successful change management
and change leadership efforts. To withstand the obstacles and resistance by those affected by the
LEADING CHANGE AT TUFTS/NEMC
5
change you are selling demands mental toughness. These are the steps that Tufts-NEMC took
when they decided they needed to hire Ellen Zane.
Lewins Change Management Model is one of the most popular and effective models that
make it possible for us to understand organizational and structured change. This model was
designed and created by Kurt Lewin in the 1950s, and it still holds valid today. His model
consists of three main stages which are: unfreeze, change and refreeze.
Unfreeze: The first stage of the process of change according to Lewins method involves the
preparation for the change. This means that at this step, the organization must get prepared for
the change and also for the fact that change is crucial and needed. This phase is important
because most people around the world try to resist change, and it is important to break this status
quo. The key here is to explain to people why the existing way needs to be changed and how
change can bring about profit. This step also involves an organization looking into its core and
re-examining it.
Change: This is the stage where the real transition or change takes place. The process may take
time to happen as people usually spend time to embrace new happenings, developments, and
changes. At this stage, good leadership and reassurance is important because these aspects not
only lead to steer forward in the right direction but also make the process easier for staff or
individuals who are involved in the process. Communication and time thus are the keys for this
stage to take place successfully.
Refreeze: Now that the change has been accepted, embraced and implemented by people, the
company or organization begins to become stable again. This is why the stage is referred to as
refreeze. This is the time when the staff and processes begin to refreeze, and things start going
back to their normal pace and routine. This step requires the help of the people to make sure
LEADING CHANGE AT TUFTS/NEMC
6
changes are used all the time and implemented even after the objective has been achieved. Now
with a sense of stability, employees get comfortable and confident of the acquired changes.
Status Quo/preparation for change
In the beginning TUFTS-NEMC was not open to the new guidelines which consisted of
mergers between health facilities. There were several external factors that led to the merger
between Tufts-NEMC and Lifespan being a failure. There was a social influence for Boston
physicians not to send their patients to TUFTS-NEMC, as TUFT-NEMC was not thriving as they
lost doctors and workers. Being removed from the accredited Harvard program which led to a
loss of in-patients and out-patients attending the hospital.
There was also internal factors that led to the demise of the partnership between TUFTSNEMC and LIFESPAN and that was that TUFTS-NEMC was not valued as a major hospital for
patients to attend on the Boston area. This was despite its appeals for the bone marrow transplant
team. The early loss of its accreditations led to doctors and other professionals from LIFESPAN
avoiding patients to attend TUFTS-NEMC, preferring patients attend Rhode Island affiliated
hospitals.
When TUFTS NEMC decided to end the merge they knew there was a need for new
leadership. This is when Zane was hired, and she knew there was a need to develop a tripartite
mission which included clinical excellence, research and teaching. Her agenda for change
included blocking and tackling. This included looking at the everyday operations which
included: the length of stay managed care contracts, accounts receivable, FTEs, supply chain,
real estate, ambulatory clinics and research. The administrative team at TUFTS- believed Zane
had the ability to pull them out of their financial crisis and ensure they could keep their doors
open and keep treating patients well in the future. During the first six months Zane, started
LEADING CHANGE AT TUFTS/NEMC
7
taking action for the much needed changes. In the beginning these changes were argued against,
but in the end it was easy to see why the changes was needed. Zane made sure she
communicated with everyone with full transparency. The vision was clear that if Zane could
improve the areas that was failing she could began to work on the future of the company. Zane
used a rapid diagnostic approach. She came in with a consultants who were fully aware of the
problems, which made it easy for them to get to the route of the cause of those problems. This
allowed Zane to begin to work on the change in staff, which led to half of the top leaders being
replaced. There was an uproar from the board of Directors, but Zane never backed down. When
she was done the board began to see she was right in her choice to get new staff into leadership
of the hospital. Once the staff began to see the morale pick up they began to see how serious
Zane was in helping with the improvement of the hospital.
Communication and outreach was very important to Zane. She felt as though the
community and internal communication was needed if they werent made aware of the changes
they would have no idea it was taking place. She made sure she communicated with staff so they
were aware of the changes. She also made the community aware of the changes that were taking
place. Creating an agenda and making it public as possible, people who thought the hospital was
going to fail could now begin to see how it planned to succeed. This provided much more benefit
and value to everyone who was focused on the hospital and the changes taking place. Zane also
involved the physicians by giving them leadership roles over there specialty. This allowed for
accountability for the success and failure over the departments. Involving staff during the
implementation allowed for their buy in into the change.
She was able to spend much more time on strategy, on the future and where the place was going.
This showed success.
LEADING CHANGE AT TUFTS/NEMC
8
Conclusion
TUFTS-NEMC knew they needed to add value-adding strategies that would coordinate
and be consistent, along with shaping the working environment, norms behavior, reporting
relationships, information flows, financial need and HR requirements to help carry out these
strategies. Zane was the perfect candidate for this. She involved staff, she communicated well by
holding town hall meeting and allowed a flexible schedule so that all could attend. She had the
strength to leverage networks and getting allies, aggressive and confident. She focused on the
vision and mission, strong wil…
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