IRI Case Studies

For more than 30 years, IRI Consultants has helped hundreds of organizations improve employee job satisfaction, enhance workplace productivity and communicate more effectively.

The following case studies contain real-world examples of what we've done. How could IRI help you? Contact us for more information at info@iriconsultants.com or by calling 313-965-0350.

Empower Employees by Giving Them A Voice

The Client

One of Michigan’s largest nonprofit residential and community-based treatment agency for abused and neglected girls.

The Challenge

An employee organizing attempt triggered, in part, by a lack of communication surrounding a change in the executive management team.

Background

When the organization’s president and CEO joined the company in December 1997, he knew he was taking on a challenge. Unfocused leadership had led to numerous struggles within the organization for years and he had been advised there was staff discontent that would need prompt attention. What he didn’t expect, however, was to be handed a Representation (RC) Petition within hours of walking through the front door.

After careful consideration and due diligence, the CEO and his executive team contacted IRI. “I knew IRI was the right choice to help us manage our employee relations’ issues. IRI wasn’t interested in being front and center within the organization. From the beginning, it was clear that they were here to help me and my team build stronger relationships with our employees.”

The Solution

Coming into an emotionally charged environment fraught with skepticism and distrust, IRI recognized that its first task was to open communication channels between management and staff. “IRI was of tremendous value in this regard,” notes the CEO. “The communications plan that IRI put together to help us connect with and educate our employees was a perfect fit with my bottom-up management style.

It played a key role in the decision of our employees not to join the union.”

Following the election, the organization implemented a number of new systems. In addition to compensation adjustments and quality management initiatives, new programs were implemented that enabled employees to become more involved in workplace planning and decision-making. Coupled with periodic staff surveys, skill training and enhancement programs, and proactive communications, the company thought it was meeting the needs of employees. Much to management’s surprise, however, they found themselves in the midst of a second organizing drive in 2005.

In the years following the first organizing effort, the facility had undergone a significant amount of change. In addition to internal reorganization, it was adjusting to new state-mandated educational, training, and licensing requirements that had created tension between the “old” and “new” employees. These changes coincided with a resurgence of organizing activity among many unions following a decline in
union membership, particularly in Detroit.

“We had to dig deeper,” says the CEO. “We had been so focused on surviving, and on the cost of surviving, that we didn’t increase our investment on the ‘people side’ as much as we needed to.

The IRI team was recalled, and this time its involvement would be deeper and more comprehensive. The executive management team was committed to creating a transparent organization – one in which employees were empowered to represent themselves and one another without third-party intervention. The goal was to rebuild the trust and respect of employees and their involvement in and ownership of
the organizations.

This organizational development “intervention” included a number of key initiatives:

  • Employee Resource Group
  • Employee Advocates
  • Employee Suggestion Box
  • Town Hall Meetings
  • Involvement of Executive Leadership in Monthly Meetings
  • Human Synergistics (key drivers/detractors of satisfaction)
  • Supervisor Training
  • Team Development
  • Performance Management System
  • “State of the Organization” Reports

The Results

Fortunately, the company prevailed again in the second union election in 2005. Since that time, they have remained vigilant about proactive communications and best practices. The results, according to their CEO, are invaluable. Not only has employee turnover been cut in half, but the organization is now thriving. This has meant increased compensation and job security for employees. Most importantly, is the sense of community that has developed throughout the company, “Our employees know that they can come to me or any other member of management and have their voices heard,” says their CEO. “This type of direct relationship has made us a much stronger organization.”

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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Executive Team Development

The Client

A Michigan-based, eight-hospital system that operates more than 100 ambulatory sites and employs more than 18,500 staff members and 3,000 physicians.

The Situation

Mergers and acquisitions led to new executive leadership, including a new president and CEO, at the 160 year-old health system.

The Challenge

To create more effective leadership at the individual and team levels by blending new talent with the longer-serving executives, then getting everyone on common ground.

The Solution

With so few executives spread across so many sites, it was imperative that early efforts at cohesion focused on key senior leaders. The IRI Consultants Executive Team Development program was designed to:

  • Access the levels of trust within (a) the organization, (b) between the Executives and Management, and (c) among members of the Executive Leadership Team
  • Identify the major obstacles to high levels of trust and ways to overcome these barriers
  • Create a structure that promotes and communicates leadership’s business competence
  • Build and practice delivery of people orientation components to increase trust
  • Develop an action plan to increase and/or restore trust of the Executive Leadership Team in the organization

Leaders at the health system were assessed on 13 core competencies, with each leader undergoing a 360-degree evaluation. The core competencies focus on personal and professional development, communication skills, technology, and a commitment to quality. The executive also completed a talent inventory listing strengths, growth opportunities, background, career goals, other business interests, and key goals and achievements in their current roles.

An annual development dialogue session is conducted outside the presence of the employee. The group consists of the executive’s boss and four other leaders who discuss how the employee can be more effective on the job, goals, and possible career moves. The feedback is then shared with the executive in the annual performance meeting.

The Results

The vision of the healthcare system focuses on a handful of system-wide critical success factors that include clinical networks, customer-service, physician relationships, and operational performance such as adoption of continuous improvement processes to heighten efficiency.

The outcome of the Executive Team Development program included:

  • The development of a communications structure that links the groups and serves to address system issues and concerns
  • A results framework for building and re-building relationships with the Executive Team
  • Benchmark targets through the utilization of “line of sight” dashboards that measure and recognize achievements
  • Team Social Styles exercises that increased the awareness of style and commutation differences within the leadership and management groups
  • Individual coaching to ensure continuity of the team expectations and secure the necessary “staying power” for long-term commitment

Leadership development is one of the keys to enable the system’s success. Dialogue among leaders takes place often, including at team meetings where one executive will share personal insights that spawns reflection, discussion, and sharing, and that encourages executives to share personal beliefs and values.

The leadership team also spends a time off-site dealing with those critical issues and long-term planning. Learning sessions focused on Malcolm Baldridge National Quality Award criteria help executives find new and improved ways to work together as a team.

Lessons Learned

Although the primary focus is on executives, the aim is for this select group’s business acumen and insights to filter through the organization, impacting every level of patient care and employee interaction.

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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Financial Institution Grows with Bold New Business Plan

The Client

A successful, mid-sized credit union with a great reputation among members but not achieving its potential.

The Situation

A new CEO, with 20 years of experience and a slate of ideas, understands that in order to grow, the credit union needs to be reorganized. Size works to the credit union’s advantage: it’s small enough to nimbly implement necessary changes and successful enough to have the financial means to execute its change strategy.

The Challenge

In any organization, some employees will resist change, and the credit union was no exception. When the CEO joined the credit union, he replaced a person who had been there for 27 years. Employees were shocked and the cultural antibody of the “we’ve always done it this way” mentality emerged. Obstacles needed to be overcome before real change could be achieved.

The Solution

The first step was to gauge the organization’s readiness for change, which was accomplished through IRI’s Issue Identification and Improvement (I3®) Assessment.

Through the assessment, management openly addressed employees’ concerns and honestly explained what needed to change and why.

In an executive off-site meeting facilitated by IRI, a three-year business plan was developed, which focused on the following change strategies:

  • Restructuring of the organization
  • Construction of a new facility, designed as a financial mall
  • Fostering a sales culture
  • Redesigning the core process and technology integration plan
  • Training and staff development

For each of these change strategies, departmental and individual plans were created to align with the overall organizational objectives.

The Results

To restructure the credit union, overlapping departments were streamlined from seven to five distinct specialties that allowed them to lead more dynamically and with greater communications. A new human resources manager was enlisted to create and administer integrated HR solutions.

The credit union now operates from a 38,000 square-foot headquarters, and has seen a 20 percent increase in membership and a 44 percent increase in assets under management. Due to extensive education and training (and a well-received employee incentive plan), the credit union effectively developed a sales culture that identifies opportunities and presents those opportunities to customers in an engaging, non-threatening manner. One of the biggest contributors to the credit union’s phenomenal growth in assets is its redesigned loan process. Previously, a 300-step process took more than 24 hours to complete; a new automated process takes 20 minutes and has added the capability to apply for over the telephone and via the Internet.

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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Government Performance Planning and Development

The Client

The city government of one of the largest manufacturing cities in the U.S.; more than 17,000 employees and 48 collective bargaining agreements.

The Situation

After years of researching, planning, and organizing, city officials began implementing a benchmark by which the city could measure its progress toward satisfying both its citizens and its employees. The process, called Performance Planning and Development, was designed to help the city achieve its core service priorities focused on the following:

  • Neighborhood stabilization and improvement
  • Improve public safety
  • Strengthen internal services
  • Improve supervisor and employee communication through training and coaching

The Challenge

To incorporate a top-down cascading process, beginning with the Mayor, to change the work culture where peak performance and customer satisfaction become the collective bottom-line by providing:

  • Clarity of performance expectations and outcomes
  • Continuous supervisor and employee feedback
  • Building effective work relationships
  • Regular conversations regarding performance
  • Alignment between employee performance organizational goals and employee development

The Solution

The Performance Planning and Development process consists of three separate yet integrated systems. These systems are: Communication, Training, and Performance Coaching. Each system is designed to work in an integrated manner with the others, as the process is cascaded down from one managerial level to the next, and then to all employees.

The Results

During the implementation phase, an initial three-hour orientation was provided for all employees. Within a 60-day period, 10,000 employees attended 156 sessions and generated more than 25,000 comments about the process. The comments were analyzed and indicated that employees overwhelmingly identified leadership skills as the key issue that could make the process work in their department or interfere with making the process work. The human resources department used this information to determine the types of training and development activities supervisors required.

Two-day training sessions for every city supervisor were conducted through the second tier of the process. Within six months, 2,000 supervisors attended 66 training sessions to prepare them about how to successfully conduct performance meetings with their employees.

Additionally, all supervisors were invited to attend one-on-one, skill-building opportunities following the training sessions.

The most unique aspect of the process is the Performance Coach role. This new role was filled by city employees who provided initial and ongoing support of the process. Performance Coaches were assigned a “service group” comprised of several departments. The coaches’ primary responsibilities were to assist in every phase of the process and are considered “subject matter experts.” They were responsible for documenting that every city employee participates in at least one performance meeting by the conclusion of the implementation phase.

According to the city’s human resources director, “Quality standards and accountability is nothing new to the city. However, quality standards and accountability organized around clearly-defined goals and focused service measures is radical realignment. The synergy reverberating across the organization is, in effect, being reaffirmed within each department because of the momentum generated by a shared vision.”

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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Healthcare Leadership Academy

The Client

A healthcare membership organization in a major U.S. city with responsibility for improving the quality, accessibility and delivery of services for more than 150 hospitals.

The Situation

The American Hospital Association’s Commission on Workforce released national recommendations designed to help hospitals improve effective leadership abilities and knowledge among supervisors and managers. The AHA group offered specific recommendations, including the enhancement of communication skills, fostering meaningful work and strengthening management-employee relations. The healthcare membership organization partnered with IRI Consultants to create a comprehensive education program focused on workforce leadership development.

The Challenge

Surveys conducted by IRI Consultants before the Academy revealed self-identified weaknesses among supervisors and managers when asked about their leadership skills. Problem areas included communications, employee coaching, evaluating performance and managing change.

The graph of survey responses illustrates that a majority of participants felt they needed help, or felt there was room for improvement in each of the seven skill areas examined. Further research and interviews discovered:

  • 31% of supervisors and managers received no formal management training prior to assuming a leadership position
  • 46% of those who had received training had attended only a seminar
  • Just 11% had received a formal certification or degree as their leadership preparation
  • 54% had been serving in a leadership role for less than three years
  • More than one-third of supervisors and managers were spending five or more hours each week on administrative duties. None spent less than one hour

Thorough self-assessment showed a deep need and desire for leadership development among these managers and supervisors.

The Solution

IRI Consultants partnered with the healthcare membership organization to create a comprehensive training program designed to help supervisors and managers with their managerial skills. The 10-module Healthcare Leadership Academy was presented in five days, over a three-month period, to healthcare leaders from the membership organization.

Using comprehensive training modules, a behavioral assessment and communication tools, IRI’s Organization Effectiveness team empowered participants to improve their skills in 10 essential areas:

  • Principles of Leadership
  • Understanding Individual Differences
  • Principles of Leadership Communication
  • Coaching Employees to Higher Performance
  • Leading Others through Change
  • Managing Performance
  • Building and Leading Effective Teams
  • Planning and Running Effective Team Meetings
  • Making Conflict Productive
  • Organizing Your Time, Work and Priorities

The Results

Following the Academy IRI asked participants to evaluate training on three criteria:

  1. Meeting the stated objectives
  2. Usefulness of the information presented
  3. The value of the training materials as useful reference material

In each of these categories, the training modules earned positive marks of 91 percent or higher. Four of the ten modules scored 100 percent on two of three evaluation questions.

Beyond the individual training modules, IRI assessed how Academy graduates perceived their own learning and self-improvement in previously identified areas of concern.

Rate how much you agree that the Healthcare Leadership Academy improved your knowledge in the following areas:

IRI also asked graduates to assess the improvement in their management abilities relative to their performance before the Academy. Respondents reported back the following (time measured in hours per week):

Time spent dealing with conflict

The time spent dealing with conflict declined slightly. Academy alumni stated that while time spent dealing with conflict remained almost unchanged, time spent on this post-Academy was used more constructively in that they acquired the skills to deal with conflict positively instead of avoiding it altogether.

Time spent mentoring direct reports

Mentoring direct reports became a higher priority, especially among those who were doing little mentoring prior to the Academy.

Time saved on administrative duties

There were measurable gains in time saved on administrative duties. The pre-Academy survey showed 35% spending five or more hours per week handling administration. This dropped to 21% after the training, allowing more time for mentoring.

Lessons Learned

Academy participants felt empowered to make changes in their work habits, allowing them to save time, prioritize tasks and lead effectively:

“I set up a weekly meeting with a low-performing staff member, which has helped me build my relationship with her and improve her performance on the team.”

“I used the new techniques I learned at the Leadership Academy to have two staff people solve a problem themselves without me interfering in the solution.”

“Since the Academy, I am…trying to communicate with everyone in their best method of understanding. I have a staff member with a dominant personality; a physician complained she was disrespectful and unprofessional. I used the tools I learned to inform her of this incident. She apologized and stated she would mind how she communicates with others from now on.”

According to their feedback, Academy graduates are spending more time on the critical aspects of their work and less time on administrative issues. They also have become far more effective communicators and leaders in their organizations. The Academy’s training modules equipped participants to manage conflict, increase productivity by building relationships with low-performing staff, and achieve better outcomes when delegating tasks. The time saved has been reinvested into mentoring employees, thereby building productive teams that are focused on delivering quality healthcare services to patients.

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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Process Improvement Cuts Bed Turnaround 75%

The Client

A multiple-Magnet, large metropolitan hospital.

The Challenge

The average bed turnaround time (the elapsed time between one patient being discharged from a room and another admitted to the same room) was more than six hours. Patients and families were inconvenienced by the delays.

Background

The 950-bed hospital admits approximately 200 patients each day who require medical, surgical, intensive care, maternal child health, pediatric or psychiatric beds. Because the hospital does not start each day with that number of available, clean and staffed hospital beds, it must rely on an intricate balance between several departments to discharge patients, clean rooms and assign rooms to new patients.

Like most hospitals, the client experienced long waits for available inpatient beds, especially in the late afternoon. Because forty percent of admissions were from the Emergency Department (ED), the client assigned the highest priority to reducing bed turnaround times for ED admissions.

The Solution

Using the Toyota Production Process Improvement Methodology, the client assembled a multidisciplinary project team to eliminate wasted time from the bed turnaround processes then in place. The team held a Rapid Improvement Event (RIE), which compressed months of process improvement meetings into four days.

The result of the RIE was a standard work agreement the client nicknamed “Toes Out-Toes In” – a documented process flow with timed work activities across multiple departments – that eliminated tremendous amounts of wasted time. Resulting waste elimination include:

  • Discharge Computer Entry. Prior to “Toes Out-Toes In,” when a patient was discharged from an inpatient bed, an RN was responsible for entering information in the hospital computer system. With many other duties, RNs sometimes had to delay making the computer entry for several hours.

    Resolution: Nurses’ aides, who transport patients out of the hospital, were taught to immediately enter the information into the computer system. The computer entry then sends an automated message to Housekeeping that the room/bed is vacant and ready to be cleaned. This one step eliminated, on average, one hour from bed turnaround times.

  • Staffing. The working hours for most of the housekeeping staff did not match the peak workflow of patients discharged in the late afternoon. Consequently, the bulk of beds that needed to be cleaned occurred when the fewest housekeepers were on duty.

    Resolution: Using best practices from the hotel industry, a Housekeeping Discharge Team was created with work hours from 10 am to 8 pm to closely match the discharge patient workload. Each discharge team member was assigned a geographical hospital zone to decrease travel time to the newly vacant room. The team’s sole function was to clean rooms of discharged patients. The average time to clean a room decreased from 75 to 45 minutes.

  • Bed Assignment. ED patients were assigned to an inpatient bed when the room was empty but not yet cleaned. ED staff had no way of knowing when the room was clean and ready for the patient without making multiple phone calls to several departments.

    Resolution: ED patients were only assigned clean and ready beds, which eliminated an extraordinary volume of phone calls between ED, Housekeeping, and Patient Placement (PP) staffs, and increased ED nurse satisfaction.

  • Bed Requests. ED physicians often requested an inpatient bed before the patient was clinically ready to leave the ED. This resulted in empty beds assigned for hours with no patients in them, while other patients could have been admitted to that room.

    Resolution: ED physicians are now more precise in their communications. They send a “cleared for admission” message to the PP department. Only then will the PP staff assign a clean and ready bed to that ED patient.

The client piloted “Toes Out-Toes In” on one 32-bed monitored nursing unit for several months to test the project’s assumptions. It monitored progress in meeting the outlined time targets daily, and made multiple revisions as a result.

To rollout the pilot to the hospital’s 19 other medical/surgical units, IRI Consultants managed the client’s communications training, data collection and interdisciplinary meetings. Throughout this process improvement project, the client consistently had the staff that actually performs the work engaged in development and assessment. Management took its lead from the employees, implemented their ideas for change, and dramatically improved the way work groups interact across Emergency Department, Housekeeping, Patient Placement and the Nursing Units. The project later was expanded to ICU, PACU, Labor & Delivery and Cath Labs. As part of the client’s continuous improvement process, IRI subsequently was asked to lead mini-RIEs to further refine the ED and ICU processes.

Project Results

Prior to “Toes Out-Toes In,” the average bed turnaround time for the client was more than six hours.

  • Initially, the client reduced average bed turnaround time to 110 minutes.
  • With refinements over several months, average turnaround time for all 20 medical/surgical units eventually was cut to 88 minutes; the goal is to reduce it to 55 minutes.
  • Total waiting time in the client’s emergency department has been cut by 30 minutes.
  • Patient satisfaction scores improved.
  • Staffing and workload were brought into alignment.
  • Employee job satisfaction scores rose.
  • Productivity increased.

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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Process Improvement by Working in Teams

The Client

Luxury automotive manufacturer and marketer.

The Situation

The auto company, known around the world as an organization committed to quality and customer service, adopted a continuous improvement process for its workforce. A team was formed to review and improve a core process within the Parts Distribution Center (PDC) – specifically the air and sea freight receiving process because it affects about 80 percent of inbound shipments.

The Challenge

The challenge the PDC faced is timely parts distribution to dealer service centers so car repairs can be made in a timely, customer-friendly manner. This meant that the creation of an efficient parts receiving process within the supply-chain.

The Solution

The goal in process improvement is to eliminate wasted effort and find the most efficient pathway for each key process. When implemented correctly, the results are and effective processes that manifest gains in employee morale and productivity. The PDC focused on key process improvement elements, including:

  • Determining process improvement goals and objectives
  • Using the existing process analysis as a starting point
  • Identifying areas of improvement in the existing processes
  • Identifying tasks, resources, roles, guidelines, and measurement

The team completed a process map and discovered that the largest source of controllable errors was in the scanning of parts. When a shipment is received at the PDC, each part is scanned so that the inventory is updated. If a part is not properly scanned, the inventory count is inaccurate, which creates downstream problems. The PDC keeps on hand in excess of $16 million of inventory, so correcting the
problem would save resources and eliminate inefficiencies while improving customer service.

The Results

Equipment errors were responsible for some of the scanning problems, whereas others were a result of process inefficiencies. The team made many recommendations to improve the process, including:

  • Change to specific process steps
  • Training for people involved in the process
  • Better maintenance of the computer equipment involved
  • The implementation of measurement systems to track the process

After implementing the recommendations, the team conducted a second study as a comparison. The results showed a projected savings of 25.5 workdays per year by improving the parts scanning process and by people spending less time correcting errors. This also resulted in a significant cost savings.

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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Rapid Resolution to Organizational Issues

The Client

A highly-regarded, 577-bed hospital in south Florida; 32,000 hospital admissions annually; 76,000 emergency room visits each year.

The Situation

The hospital, which prides itself on treating patients as valued guests, and its employees as valued members of their hospital family, is committed to being one of the nation’s leaders in work/life-friendly policies. Administrators were taken by surprise upon learning of growing dissatisfaction among employees in areas such as communications, decision-making processes, and other work environment issues.

The Challenge

Identify the source of employee dissatisfaction, address the issues, and restore and maintain a positive work environment.

The Solution

The solution was to help the hospital’s leaders identify and better understand employee concerns. This was accomplished through the establishment of Employee Advisory Groups (EAG), which provide focused employee input that can be considered and incorporated into executive decision-making and problem-solving.

Employee Advisory Groups are designed to:

  • Provide a forum where employees can openly voice concerns and raise issues
  • Increase integrated communications
  • Provide a lasting and official structure for communication up, down, and across the hospital
  • Enhance management’s awareness of stresses impacting employees and productivity
  • Develop mutual respect and trust throughout the organization
  • Provide a confidential atmosphere for discussion of issues, problems, and potential solutions
  • Strengthen the organization through a more engaged work force

Employee Advisory Groups include employees from across the organization who can provide the unique perspective from each department or unit of the organization. IRI led the hospital’s team in creating the EAG Mission, defining membership, designing operating guidelines, and establishing the membership process and role definitions. Additionally, IRI consultants facilitated the meeting structure, education
of members, and forum assignments.

The IRI approach to creating Employee Advisory Groups is a proprietary process called Fastrack Teamssm – IRI’s rapid resolution program. Fastrack Teamssm provides measurement-driven results in a compressed timeframe and within a clearly specified budget. The key to this successful process – which relies on teamwork – is identifying the right people in the organization who can quickly analyze the situation, find solutions, and implement them immediately.

The Results

Senior management observed the initial Fastrack Teams program that facilitated a group of vice presidents, directors, managers, supervisors, and employees in the formation of the EAGs. The success of the EAG helped management better understand employee concerns, solicit ideas and input, anticipate and understand the effects of management’s decisions on employees, and learn how to communicate more effectively. Since implementing the EAG, employee satisfaction has risen considerably – leading to a more informed staff that feels more engaged and vested in organizational strategy.

The hospital uses a continuous improvement (CI) process throughout the facility as a method of achieving process improvements. The Fastrack Teamssm process has been instrumental in many of them, including the following select list:

  • Patient Care Redesign
  • Social Workers Scheduling
  • Critical Care Visitation
  • Pharmacy Scheduling
  • Rehabilitative Services Scheduling
  • Respiratory Therapy Redesign
  • Employee Advisory Groups
  • ED Management Restructuring
  • ED Triage Examination Area Launch
  • Lab Specimen Transfer Process
  • Rehabilitation Productivity – Acute, Inpatient, Outpatient Ortho, Outpatient Neuro
  • Emergency Dept Security
  • Social Work – Lost & Found Process
  • ED Expanded TSU Dept.
  • Noon Checkoutsm – Testing Services, Global Discharge Process, Physician/Nurse Expectation

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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Shared Governance Improves Patient Care

The Client

A multiple-Magnet, large metropolitan hospital.

The Challenge

Nurses were dissatisfied with the amount of input they were able to have about patient care delivery.

Background

The 950-bed hospital provided patient care equal to or better than any comparable facility. Despite this clinical excellence, nurses believed that care could be even better if their ideas were sought and listened to.

Analysis of the employee attitude survey that was administered as part of the client’s Magnet recertification process indicated that a house-wide shared governance process was needed to significantly increase nurse engagement, job satisfaction and satisfy such other Magnet criteria as:

  • Delivering excellent patient outcomes
  • Low nurse turnover rate
  • Appropriate grievance resolution
  • Involvement in data collection
  • Decision-making in patient care delivery
  • Open communication between nurses and other members of the health care team
  • An appropriate personnel mix to attain the best patient outcomes and staff work environment

As is true in many large hospitals, the client’s management system had decisions typically made at the top of the organization and by physicians, with less than optimal input from bedside nurses.

IRI Consultants helped the client create a network of 46 Unit Practice Councils, the purpose of which is to promote quality patient care by providing a forum for improved decision making at the point of service. The councils seek to foster the professional growth of bedside nurses and tap into their collective insight and experience in addressing issues important to staff, patients and physicians.

These councils, part of a larger shared governance process designed with help from IRI, were intended to create an environment where nurses and other patient care providers could say, “I have an opportunity to make my voice heard in decisions that affect the care of my patients.”

The following illustration shows how unit practice councils interact with the other components of the client’s shared governance structure.i

The Unit Practice Councils have the latitude to advise and guide on such issues as:

  • Reviewing and revising clinical policies and procedures
  • Identifying and acting on system and process issues impairing work performance
  • Cultivating respectful communications and a positive team culture
  • Promoting a culture of accountability in which all members view their participation as critical to quality outcomes
  • Evaluating unit practices against established performance standards
  • Assessing training needs and introducing appropriate training

Essential to the success of the Unit Practice Councils was developing and measuring success benchmarks that nurses, physicians and the administration agreed were valid. The following four indicators of success were selected:

  • Staff members feel empowered and accountable to participate in the betterment of the unit. All members view themselves as having shared accountability for unit problem solving and improvement of outcomes.
  • Issues are heard, actions are taken. Issues of concern to staff receive proactive attention and resolution at the unit level.
  • Actions of the team are highly visible within the unit. Issues under consideration and actions taken are conspicuously posted and communicated to all staff.
  • The staff takes increased pride in the unit, teamwork grows stronger, communication improves, patient, physician and staff satisfaction increases, and newcomers are attracted by the positive spirit and energetic commitment evident within the unit.

Implementation

IRI helped the client establish the Unit Practice Councils’ guidelines and procedures, as well as train council members. Two councils were established initially; each consisted of approximately eight RNs, including the unit manager. All councils include employees from each shift. Meetings are held monthly or more often if necessary.

In true shared-governance fashion, the Council selected a chairperson; rarely was the chairperson the unit manager – which often caused confusion. Accustomed to being “in charge,” some managers exercised so much control that meetings became monologs, not a conversation among all eight members. Other managers viewed their council as a “staff group,” and were minimally – or not at all – involved. Calibration was needed, and IRI helped provide mentoring and additional training.

Unit Practice Council training, which takes one day, provides members with the skills and resources needed to maximize the group’s effectiveness. Training subjects included:

  • Membership selection
  • Agenda development
  • Taking minutes
  • Problem solving techniques
  • Case study in meeting management
  • Setting goals & measuring outcomes
  • Influencing others
  • Action planning

Because the shift to shared governance from a traditional command-and-control culture represented a top-to-bottom overhaul of how the hospital functioned, as well as the culture that dictated how thousands of employees interacted with one another and with patients, there was a great deal of uncertainty and apprehension at first. From the C Suite to the house service night shift, everyone in the hospital knew this wasn’t just another “flavor of the month.” Everyone also knew that it was a process, not an event; it was never going to be “done.”

Fine-tuning occurs continuously. Variations to accommodate specific unit needs are made within the system’s overall guidelines. Not surprisingly, the greatest need for ongoing mentoring and coaching has been among managers, supervisors and directors; culture change can be traumatic and slow, especially to those who have to relinquish some control.

Project Results

Shared governance has had highly positive affects on the client’s patient satisfaction and safety, as well as on team satisfaction and nurse turnover. The following charts illustrate.

Team development/staff satisfaction: Question #11
“I am part of an effective work team that continuously strive for excellence even when the conditions are less than optimal.”

Team development/staff satisfaction survey - Question #8
“I work within a supportive environment that nurtures my professional formation and development.”

i The seven divisional Clinical Practice Councils design and implement best practices of patient care. The Patient Care Council approves and integrates clinical practice and performance improvement for patient care safety, service and quality. The Nursing Research Council provides mechanisms for research and clinical investigation relevant to nursing care delivery, and disseminating and applying research outcomes. The Nursing Education Council implements education and career development programs. The Advanced Practice Council promotes professionalism and evidence-based practice, guidance for unit-based peer review, mentoring and strong clinical leadership. The Nurse Manager Council champions peer development and peer review processes, and facilitates interdepartmental communication and feedback. The Nursing Coordinating Council assures consistent nursing practice across the organization, monitors progress with organizational objectives and the hospital’s strategic plan, approves policy and nursing practice standards. With the exception of the Nurse Manager Council, all councils have staff nurses as full participants.

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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Supervisors Academy Provides Empowerment and Organizational Change

The Client

One of the largest cities in the United States and a major Great Lakes port with globally renowned legacies.

The Situation

A new administration signaled that business as usual in city government practices required change. Leadership also acknowledged the demand to improve existing performance and management process, and to raise the level of individual initiative and accountability among city workers. The existing processes supported a status quo attitude and required a transformation to reflect the vision of the new administration. It was decided to revise the city’s performance philosophy as part of a goals-based governance system.

The Challenge

The city needed to provide leadership skills training for supervisors within the context of a cultural change. At the same time, the city wanted to:

  • Encourage supervisors to assume decision-making responsibilities
  • Promote cross-departmental cooperation
  • Provide a foundation upon which other leadership training could be built

The Solution

IRI Consultants collaborated with the city to create an integrated training initiative that enabled supervisors to have greater decision-making responsibility without waiting for additional instructions and direction. To provide the tools needed to move the city toward these goals and objectives, IRI designed the Supervisors’ Academy to instill pride and a sense of empowerment among city employees. The Supervisors’ Academy focuses on the concept that in today’s environment, there is no prescribed set of “right” answers, rather multiple sets of best options. The academy teaches participants how to make informed decisions from these options.

The Supervisors’ Academy applies real-life scenarios, using a variety of teaching tools, to challenge the question: “What are the barriers that keep you from getting work done?” Role-playing allows the participants to differentiate between perceived barriers, barriers that they can deal with, and barriers beyond their control. In a highly interactive environment, the participants find they share more common problems than individual and/or disparate problems with others.

The Results

The Supervisors’ Academy develops a sense of excitement, encouragement, and personal satisfaction in the participants. But, it also uses a series of critical measurements that provides a system of ongoing feedback to city leaders, defining new and recurring barriers. These barriers are gathered on the first day of the five-day academy, sorted into categories, input into a database, and analyzed. The data serves as a barometer for the city regarding concerns of the supervisors and shifts in attitudes over time.

Lessons Learned

The city has profited measurably from the Supervisors’ Academy. Not only has the academy provided individual learning skills for the participants, but it has provided a platform for coordinating the goals of the city to improve its long-term performance, work processes, and communications. This organizational development emphasis uses social science to accomplish objectives. It targets the city’s culture, including systems, processes, and rewards. By working on “people” issues, it allows positive and lasting change at a relatively low cost.

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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Team-Based Approach to Structured On-the-Job Training

The Client

One of Canada’s largest petro-chemical plants.

The Situation

An innovative plan was needed to incorporate on-the-job training for a biennial event at the plant – an event that, if done incorrectly, could result in serious operational and safety issues.

The Challenge

A complete power switch from one source to another is performed for maintenance reasons. The trick to the electrical switching is to take one of the two feeder lines out of service while keeping the internal electrical grid balanced so the plant runs without interruption. The switch is difficult for employees to perform because of its infrequency.

The Solution

The plant’s training coordinator identified problems with the way the technical training process was being conducted. Training information often was misplaced, the curriculum was not developed according to any proven method, and some of the trainers did not receive train-the-trainer instruction.

To address these issues, IRI Consultants designed a curriculum architecture that could be used and maintained by internal facilitators without instructional design backgrounds. The architecture would work to increase the comfort level employees had with their jobs by increasing the effectiveness of the technical training they received. To do so, the organization reengineered several business processes, which led to adopting a Self-Regulated Teams model, a team-based approach that subsequently reduced the levels of management involvement.

IRI course developers created a design built on the principle of Structured On-the-Job Training, coupled with an introductory (pre-) session and a review (post-) session. By using this design, facilitators would be able to practically apply technical training to the real-work experiences of operators. The design was presented to participants in three levels: Heard It, Seen It, Done It. In the first level operators would be taught how to do the tasks; in the second level operators would watch someone perform the tasks; and finally in the third level they would actually perform the tasks.

These sessions were critical to helping employees understand not only what to do, but why to do it.

The Results

As a result of the training, comprehensive reference materials were developed, including a participant’s manual and job aids. Operator confidence increases because they learned the what, why, where, and how of the operating equipment that many employees had not a chance to touch due to the infrequency of the operation.

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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University Puts Improving Process Performance to Work

The Client

A premier technical and professional university with more than 12,500 students, 850 faculty members and 500 staff members.

The Situation

Critical human resources processes included a cumbersome, paper-based hiring process with more than 110 steps to complete.

The Challenge

Increased efficiencies were needed to streamline the hiring process.

The Solution

A new Web-based recruitment system was developed by utilizing IRI Consultants’ Improving Process Performance (IPP) program. The program helped university employees learn how to work in teams and collaborate to make the recruitment process measurably better. A “Hiring Process Review Committee” was formed to streamline the process and eliminate steps that did not add value.

Employees at all organizational levels became highly resourceful in the use of group process skills and analytical tools. The purpose of improving process performance is to increase quality by being able to:

  • Identify opportunities for process improvement
  • Use criteria to select the best opportunities
  • Describe the opportunity through a mapping process
  • Identify and quantify stakeholder requirements
  • Identify gaps between stakeholder requirements and process performance
  • Find why gaps exist
  • Identify solution(s) to reduce or eliminate gaps
  • Institutionalize changes throughout the organization

The Results

The reengineered hiring process has provided numerous benefits for the university, such as increasing the time-to-hire, lowering the cost-per-hire, and ultimately, increasing the quality of hires. The Web-based solution integrates every aspect of the recruiting process, from requisition management to complete candidate sourcing and automated communication and data storage.

Lessons Learned

Feedback from university personnel has been overwhelmingly positive and the university earned the Midwest Best Practices Award from the College University Personnel Association for its initiative.

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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“RESPECT” – Focus on Diversity

The Client

An Ohio-based brewing facility employing self-directed, cross-functional teams responsible for managing aspects of production, quality, cost, safety, and employee relations.

The Situation

The plant’s labor contract states that the brewery is “built on the premise that employees are capable of making decisions affecting them when given the proper training and resources. Employees working in teams are, therefore, expected to resolve the issues that impact them.” The corporate slogan is “Great People, Great Company, Great Beer!”

At the Ohio plant, a series of diversity training sessions and other organizational initiatives had been established, but weren’t achieving intended objectives. The resulting environment created tension that reduced employee morale, productivity and quality.

The Challenge

Management discovered that it takes a unique set of skills to educate employees about diversity and respecting differences – and is especially difficult if trainers, management in this case, bring their own “baggage” to the situation.

The Solution

Initially, the Ohio plant created a multidisciplinary team to address these issues. Members included union representatives, management and human resources. The group sought to find an outside consultant to help them with the problems they were unable to resolve themselves.

IRI Consultants was selected because “they challenged the group to confront the real issues and commit to necessary change before work began. That’s what made them stand out.”

As the process continued, it involved more than simply training people about diversity. IRI helped the organization through serious issues. Communication strategizing and planning were key elements so that employees were able to understand their roles and how they contribute to the organization’s success.

IRI also helped to enlist individuals who were trusted by employees to communicate with them. Union representatives and other key people were asked to work on the project, address any “diversity” issues they may have, and only then would communications begin with employees.

The Results

Following an organization-wide assessment, issues were identified and a training and education program was developed to create awareness and address diversity issues on an ongoing basis.

For more information contact IRI Consultants at info@iriconsultants.com or by calling (313) 965-0350.

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