Correlation Between Employee Morale and Management

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A QUALITATIVE ASSESSMENT OF THE CORRELATION BETWEEN EMPLOYEE MORALE AND MANAGEMENT AT BOND COMMUNITY HEALTH CENTER, INC.

Abstract

Very similar to the mission of Barry University, this research may very well make light to knowledge and truths that could help assist in the reverse of the damage to the employee morale at Bond Community Health Center. An organization that started in off as a small idea grew into something great. A small community in Tallahassee, FL realized the need for better health care and acted on that need. With the success of Bond Community came upper management changes that made impressions on the employee morale for the organization. The trust that staff possessed for their once believed CEO was deterred after a few bad personal decisions brought light to deficiencies that were previously overlooked.

Conclusions were drawn by interviewing employees, researching health centers that have underwent similar circumstances, and the use of classic Public Administration theories from D.M. McGregor, H.A. Simon, A.H. Maslow, and D.F. Thompson. Another supporting method was the reviewing of local news articles that show the increase in public scrutiny that began the concerns from employees. The assumptions from the research proved that the hypothesis was correct. It is indeed possible to increase employee morale. And there are several resources that are available that could assist in guiding management in the right direction.

TABLE OF CONTENTS

Introduction…………………………………………………………………………………. 4

Literature Review…………………………………………………………………………… 5

Background…………………………………………………………………………. 5

Public Interest……………………………………………………………………….6

Political Attacks……………………………………………………………………..7

Community Impact…………………………………………………………………12

Problem Drivers and Issues…………………………………………………………13

Methodology………………………………………………………………………………..14

Needed Strategic Planning………………………………………………………….15

Environmental Changes…………………………………………………………….16

Findings…………………………………………………………………………………….17

Patient Centered Medical Home Status…………………………………………….21

Discussions…………………………………………………………………………………22

Change management to occur………………………………………………………22

Employee Interview…………………………………………………………………23

Employee Emotions…………………………………………………………………24

The need for innovation…………………………………………………………….25

Management Roles………………………………………………………………….25

Recommendations…………………………………………………………………………..29

Interview with the competition……………………………………………………..29

One Minute Manager……………………………………………………………….32

Conclusion…………………………………………………………………………………..32

Introduction

Could a small idea by community members flourish into something great? Proof that this far-fetched idea was obtainable was endorsed in the creation of the Bond Community Health Center. When we have ideas we never really know what the end result will be. We may come up with an idea for personal gain or to benefit people we care the most about. No matter what the original motive is, there is always the same anticipated end result. And that is to successfully achieve the goal that was once a mere thought. Bond Community Health Center was that mere thought that has developed into a fully staffed primary care center, dental suite, pharmacy, four satellite facilities, and a developing specialty care center.

Most organizations face some sort of unforeseen circumstance at some point. And like most organizations, Bond Community Health Center has faced challenges over the last two years. Survival in these times is the key but what is a captain without his crew? Have management changes and decisions impacted employee morale? Regardless of the answer, a solution is needed and quickly to preserve any remaining faith in the organization that the employees have.

A QUALITATIVE ASSESSMENT OF THE CORRELATION BETWEEN EMPLOYEE MORALE AND MANAGEMENT AT BOND COMMUNITY HEALTH CENTER, INC.

Literature Review

Background

Dating back to 1972 a small group of concerned residents on behalf of Bond Elementary School and area churches saw the need in the community for change. The group formed a committee known as “The Bond Community Management Committee” with efforts to fill the current committee voids and to increase the quality of care that the community lacked at that time. The committee became a driving force in the community raising light to issues that were ignored for years. One of the first examples of the committees’ desire for change was demonstrated in the creation of a recreational center providing a safer place for the community to hold recreational activities. The result of those thoughts was the creation of the Walker-Ford Recreation Center in 1976. Today that recreation center is known as the Walker/Ford Community Center and they offer a vast variety of recreational activities for the community and surrounding areas. Later in 1981, the Smith-Williams Service Center was also developed and this center was funded by Community Development Block Grant. The Smith-Williams Center was initiated to provide after school care for preschool age children, a health clinic, library, and social service support. These services were ran by the Leon County Public Library, Big Bend 4-C, and the Leon County Health Department.

The Bond Committee later received the assistance of the Leon County Health Department and the Bond Clinic was created.  Three years after the opening of the Bond Clinic the Leon County Health Department threatened to stop supporting clinic. One of the areas physicians produced a proposal that would request funds from the Community Development Block Grant. The proposal was accepted and funded the first year for $70,000. In September of 1994, the Bond Clinic received funding from the U.S. Bureau of Primary Care and the Health Resources and Services Administration (HRSA) to function as a Federally Qualified Health Center allowing the center to become Bond Community Health Center, Incorporated.

Bond Community Health Center is located at 1720 South Gadsden Street in Tallahassee, FL. Bond’s mission is to provide quality comprehensive access to care to Leon county and surrounding counties regardless of an individuals’ ability to pay. Bond offers a sliding fee discount for the uninsured that is based off of the Federal Poverty Guidelines. Bond also accepts private insurances and has multiple in house grants for the uninsured. The main goal of the center is to assist in the community efforts of living stronger and longer by providing access to the underserved. Bond is known for being the primary home for HIV/AIDS patients and is well staffed with outreach and case workers that are readily available to assist and offer affordable care under the Ryan White grant.

Public Interest. Today, the Bond Community Health Center has four satellite sites; Kay Freeman Health Center for the Homeless, Bond Apalachee Wellness Integration Center (BAWIC), Bond Housing Authority Primary Care Center, and the Bond Community Mobile Unit. In addition to its satellite facilities, at the main campus dental, pharmacy, and transportation services are offered as well. The Kay Freeman Health Center provides primary care services to the homeless population. The staff at Kay Freeman also offer social services along with referrals for mental health and dentistry. This site has been temporarily closed due to budget cuts. BAWIC is located inside of the Apalachee Center to provide primary care services to the residents. The Apalachee Center is an outpatient facility that offers behavior health services to children and adults. In addition, the Apalachee Center offers care management, psychiatric evaluations, and psychosocial rehabilitation services. The Bond Housing Authority Primary Care Center (Bond-HAPCC) offers primary care to residents of the Springhill Apartments on Joe Louis Street and other residents of the Tallahassee Housing Authority. This site is located in the heart of the Springfield Apartments complex. BHAPCC is a grant funded project and is one of the few housing authority primary care centers in the state of Florida. This innovative change for Tallahassee has brought convenient awareness of health care to the underserved. The last satellite site is the Bond Mobile Unit. The mobile unit serves the state of Florida residents of Leon and surrounding counties. The mobile unit operates by a schedule traveling to various locations providing community outreach and minimal primary care services. The mobile unit can be seen at health fairs, churches, and other social events. Bond is also in the planning stages of reopening Bond’s Specialty Center which will offer diabetic education classes, chiropractic, ophthalmology, and podiatry services. The specialty site operated from October 2013 until July of 2014 but was forced to close to due financial restraints. The closing of this site also resulted in employee layoffs.

Political Attacks. For several months Bond Community Health Center was featured in the local news and newspapers and all that was reported was not always in the favor of the only community health center in Tallahassee. There were years of upward progression for the center. But many residents of Leon and surrounding counties have unfortunately witnessed the rise and decline of the image of Bond Community. Instances such as in 2012 when the CEO at that time J.R. Richards faced DUI charges. The community and the center were in complete shock. The Board at Bond Community was faced with a battle of loyalty to the CEO that took his vision for the center to lengths never imaginable or doing what was ethically best for the center as a whole. The fact was the image of the CEO was ruined once the media became involved and knowledge of the CEO’s prior DUI and arrest history became public. News reporter Lanetra Bennett (2012) reported that:

C.E.O. Junior Richards was arrested for DUI. Reports show that Junior Richards has a previous DUI arrest in Atlanta, Georgia. He was arrested in Tallahassee this past weekend. Police say the CEO of Bond Community Health Center was leaving a Cinco de Mayo celebration. The C.E.O. of Bond Health Community Health Center in Tallahassee is on paid administrative leave after being arrested for D.U.I. Tallahassee Police say around 11:40 Saturday night, Junior Richards hit a car, causing it to crash into another car. Police say it happened at East Park Avenue and Magnolia Drive. Richards’ attorney Ian Nesbeth says, “Based on the limited amount of evidence that we have now, we believe it’s a very defensible case.” An officer on scene says Richard’s “eyes were glassy, bloodshot, and watery,” and the officer says they could smell alcohol coming from Richards’ car, which was a convertible with the top down. The officer says Richards said in a slurred manner, “I’m not drunk.” But, the officer says Richards could not keep his balance during the field sobriety test. The report says Richards ended up saying, “Just arrest me. I’ll just go to jail tonight.” (Bennett, 2012)

After months of being on administrative leave in September of 2012 the board made the difficult decision to release Mr. Richards and begin a search for a new leader. The board had a very difficult time making this decision since Mr. Richards played a major role in the success of the organization thus far. But this decision was one the board felt was ultimately in the best interest of the organization. After the dismissal Debra Weeks, Chief Administrative Officer of that time, took on the role as interim CEO until a replacement for Mr. Richards could be found.

In the spring of 2013 after a routine audit, Bond would begin to face the peak of its political issues after financial irregularities were found that were linked to the former CEO, J.R. Richards. This was a dilemma that was out of the scoop of Debra Weeks’ experience. And to add to this difficult time period, the organizations CFO resigned. Immediately after the audit, Ms. Weeks began to lash out at employees and as a result, the bulk of the employees at Bond Community began to lose faith in its current administration. The continuation of new challenges were in the horizon at this point for. The two top challenges for the center was the loss of the faith of its biggest known community supporters and the county threatening to withhold $800,000 worth of funding.

For many years Bond Community’s biggest supporter was County Commissioner Bill Proctor. The concerns of Mr. Proctor initially appeared to be concerns for the patients, staff, and community. After being denied his usual access to Bond’s administration, Mr. Proctor became the conductor of the train to point out every flaw that the center faced. Bill Proctor decided to hold a town hall meeting and Bond Community was the topic of discussion. He came equipped with grant information and negative allegations from Bond’s current staff. Bond’s board members declined to attend the meeting feeling that they were invited to audition for a circus since Proctor’s view of the center was tainted. And it was evident that the attacks against the center that he so loved for years had personal motivation. It was ironic that the allegations started once Antonio Jefferson, Bond Community’s new board chair, stepped into the position. News reports from Andy Alcock highlighted the argument of Bill Proctor and found that:

Leon County Commissioner Bill Proctor sent a letter on Wednesday to Bond Board Chair Antonio Jefferson asking for his resignation. Proctor claims Jefferson is responsible for improperly placing the clinic’s mobile van in Gretna. Jefferson serves as city manager there. However, Jefferson says the mobile clinic was coming to Gadsden County long before he became chair four months ago. He says he had nothing to do with the mobile unit’s placement, but says Gadsden County is part of Bond’s coverage area. “I’m greatly saddened by Commissioner Proctor’s actions of recent,” said Jefferson. “This latest event for him calling for my resignation is even more saddening,” he said. Proctor also led an effort to suspend county funding for Bond. Jefferson says he’s made several attempts to meet with Proctor to address his concerns. But Proctor hasn’t met with him. Jefferson says he doesn’t plan to send a written response to Proctor’s letter calling for his resignation. He says he’d only step down if asked by the other board members. Jefferson is four months into a two year term as chairman. (Alcock, 2013)

Since the initial attacks, Bill Proctor has since changed his views towards Bond Community. The county believed that some of the accusations that Proctor stated were true but there was obvious personal feelings attached to the claims. The center did in fact experience a decrease in the quality of patient care and faced horrible turnover rate so the concerns of the county were in fact fair which lead to the suspension of county funding. A suspension recommendation that was led by Proctor. The county requested a more transparent relationship with the center. They also requested an action plan to fix all irregularities discovered in the audit that exposed the center earlier in the year.

Bond Community Health Center would face two other unexpected issues. Bond lost the faith of its employees and would have a difficult time regaining it. All the media scrutiny raised concerns from some employees that the board members and administration of that time were unable to answer. Every question that the employees inquired about held merit because for most Bond Community Health Center became a sense of security for the employees and their family. But the staff was forced to come to an establishment where the moral of the entire organization was low and they were faced with local news crews daily. This became difficult and the staff began to wonder if there was some truth to the Medias allegations. And if their jobs were secure at an organization facing such drastic financial difficulties.  The next issue was an increase in patient No-Shows to appointments. As journalist Kaplan-Lewis and Percac-Lima (2013) noted that the increase in patient No-Show excuses were of patients that experienced miscommunication and those that completely forgot about the appointment and their research found:

Demographic data were collected on all adult patients’ who had scheduled appointments during the study period and analyzed using 2-sided t test of proportions to determine if race, ethnicity, language, gender, age, and insurance differed in patients who no-showed, compared with those who came to their appointments. Among patients who had no-showed, we also compared demographic characteristics of patients who were interviewed by phone to those who were not reached. The unit of analysis was the no-show visit and patients that no-showed multiple times during the study period may have been called more than once (Lewis & Percac-Lima, 2013)

But Bond began to question the validity of instances such as the patients forgetting appointments or miscommunication.  When it comes to Bond Community were the patients in fear of all things that the media and Commissioner Bill Proctor accused the center off? Or were the theories of Kaplan-Lewis and Percac-Lima true?

Community Impact. It is known and documented that in most communities in which community health centers are located, the population that the community center is intended to serve will not use all the resources available to them. Many people are afraid of knowing what is actually going on with their bodies. The community and the patients suffer the most when government funding is suspended or demolished. Once a patient establishes care with a physician a relationship is built. And the attractiveness for parents to have the access to bring their whole family for primary care all under one roof is a plus. With Bond Community offering primary care, pediatric care, dental, social service, and behavioral health in one facility is ideal.

According to Jeanette Lancaster (2007), there was an African American woman with 3 kids and an abusive husband. She neglected her own health needs because she struggled for the necessities in life like food, shelter, and clothing for her kids. With preventive care being last on her list of priorities especially with time the time constraints of three jobs she was shocked to learn that she was living with metastatic breast cancer. Community health centers are designed to be the place where all of your family’s health care needs are met. It’s really convenient for the many women like the one in this journal to receive needed wellness visits at the same place as her children. Especially since physicals are mandatory for children this would increase the probability of the parents being seen and also establishing care.

On September 30, 2013 protester stood outside of law of office of Bond Community’s General Counsel Office chanting for the resignation of the Boards Chairman, Antonio Jefferson, as well as the General Counsel himself, Harold Knowles. The protester held signs indicating that the two were wasting tax player dollars and contracts were signed for lease properties that were not occupied. The protesters even chanted that the General Counsel was receiving an annual salary of $90,000. The protesters organizer told news reporter, Andy Alcock, that, “Harold Knowles has quietly stayed in the background while Jefferson has been the person to speak but everybody knows its Harold Knowles” (September, 2013). The alleged abuse of the centers funding was the concern of the protesters.

Problem Drivers and Issues. In the spring of 2012 Bond Community’s chief executive officer was arrested for a DUI and after 4 months of being on administrative leave, the company relieved him of his duties. The chief administrative officer was appointed as the interim CEO that position was permanently filled. During the CAO’s interim CEO tenure, she created distrust among the staff resulting in the lowest known morale within the organization history. After discovering financial discrepancies, the CAO was also released and the newly placed chief financial officer was placed as the interim CEO. In December of 2013 Bond’s board of directors nominated a new official CEO and by this time the organization was in financial shambles, behind on mortgage payments, and the staff did not have faith in the administration. The new CEO stepped into a bigger mess than he probably ever expected and there were long days ahead of him. There was also the placement of a new CFO and Chief Operations Officer a few months later. The new administration would have to convince the staff to trust administration again and that their livelihoods were safe in hands.

Short of a complete year, Bond’s CEO Bernard Goodman was terminated. This decision was made by Bond’s board of directors. The termination of Goodman’s contract was presented to the staff in the fashion of a meeting expressing the boards’ lack of pleasure in the recent decisions of the CEO. The board felt it was in the best interest of organization and all affiliated stakeholders. With this announcement the board appointed the organizations Medical Director, Dr. Temple Robinson, as the interim CEO. She will also maintain the position of medical director during her time as interim CEO. Board Chairman, Antonio Jefferson, stated to local newspaper Tallahassee Democrat (2014) that,” It was in the best interest of all of Bond’s stakeholders that his service to the organization ends,” the release said. “We look forward to working with our staff, patients, stakeholders and community partners to strengthen our institution so that we may continue to provide quality medical services to the 16,000 patients we serve. We believe Dr. Robinson is just what the doctor ordered.” (Democrat staff, 2014)

Methodology

The best approach to address the current problem Bond Community Health Center is facing with the decrease in employee morale would be to research best practices among other health care facilities. A qualitative assessment of the influence that management has made on employee morale was explored. This qualitative assessment was done by interviewing an employee and the review of journals. The journals reviewed were of similar situations and facilities. The use of 4 classic Public Administration theories from D.M. McGregor, H.A. Simon, A.H. Maslow, and D.F. Thompson were also use to examine historic administrative approaches and techniques. Many organizations have failed prior to the fall of Bond Community. But with the recognition and efforts of management to turnaround these ill feelings of the staff have proven to be possible for numerous organizations.

Also the examination of ways to improve employee morale was done. Author H.Singh (1998) made light to that fact that even Napoleon kept the morale of his troops high with limited resources. Then Singh went on to state that:

One thing is however certain. All managers would agree that in the long term, high employee morale is essential for organizations to attain their goals and objectives. High morale usually equates to employees being more happy, more committed to their jobs and being more productive. This in turn enhances communication and reduces staff turnover.

Perhaps the secret is to monitor the state of morale and take corrective action whenever it is low. At least in this manner, there will be a situation where morale is maintained at a desirable level. Through early detection of morale deterioration, major problems can be avoided and corrective action taken so that the state of morale can be sustained, if not enhanced. (Singh, 1998)

Needed Strategic Planning

The process of strategic planning is the heart of success for every organization. Strategic planning is the process that an organization develops for achieving success and reaching organizational goals. Strategic planning has multiple steps for success that could revolutionize an organization if properly followed. The new administration must analysis the current, define the future state, determine the objectives, and then implement and evaluate the strategies.

Freshly stepping into the organization changes would have to be made. There are multiple models and ways to produce a successful strategic plan. The recommended changes could be done through the ten- step strategic planning process. Bryson (2011) listed the ten steps as (p. 44-45):

  1. Initial Agreement- initiating and agreeing on a strategic planning process.
  2. Mandates- identifying the organizational mandates.
  3. Mission/Values- clarifying the organizational mission and values.
  4. Internal Environment- assessing the external and internal environments to identify strengths.
  5. Strategic Issues- weaknesses, opportunities, and threats.
  6. Strategy Formulation- identifying the strategic issues.
  7. Strategy and Plan Review and Adoption- reviewing and adopting the strategic plans.
  8. Description of Organization in the Future- establishing effective organizational visions.
  9. Implementation- developing an effective implementation process.
  10. Strategy and Planning Process Reassessment- the reassessing strategies and the strategic planning process.

Environmental changes. The environment and organizational structure at Bond Community Health Center mirror many other community health centers. In private sectors, governments are just as complex as those for public sectors. In the beginning Bond was considered a public sector because of its sources of funding. But being an ever changing environment, the organization is moving towards the private sector. The funding in the beginning for Bond Community was mainly from the federal government and Leon County. Unfortunately after a recent county vote, Bond lost most of its county funding. In turn, the federal fund matching will be impacted. The environment can easily be classified as having cultural conditions as stated by Rainey (2010). The organizations conditions have “predominant values, attitudes, beliefs, social customs, and socialization processes concerning such things as sex roles, family structure, work orientation, and religious and political practices” (Rainey 2010). The organization is currently in need of restructuring. The way that the communication flows is not the best for the staff. In an environment that is so fluid and dynamic, Bond must adapt to its new changes. Here is Bond’s newly set vertically hierarchy structured organizational chart.

 

 

Findings

Obviously, Bond Community Health Center is not the first community health center or health care organization that has faced adversity. Research was done by viewing other health care organizations that have been challenged by similar issues as Bond. One of the first issues that Bond faced with the changes in administration were rumors of the organization having layoffs. Walsh’s (2003) study found the following:

In an economy rife with cutbacks and layoffs, rumors have become rampant. Employees turn routine developments into doomsday forecasts. Sometimes, rumors offer some level of truth, but the mill spins them into something far beyond what eventually happens. Rumors offer challenges and setbacks for workers and employers – battering morale, lowering productivity, harming relationships with customers and creating mistrust… Any number of developments can start rumors.

Employees see a conversation between managers or notice more closed-door meetings. Sometimes, workers assume things based on economic or business conditions. At USAA Insurance, rumors flew after the company put up a real estate sign for part of its Briargate property. The predictions began almost immediately: USAA is going to close its 1,170-employee local call center. To fuel that argument, employees pointed to growth at USAA’s Phoenix operation… Many times, rumors are based on a grain of truth (Walsh, 2003).

This study was conducted to examine the effect on employee morale for companies Worldcom, USAA Insurance, and Intel which all faced rumors of their businesses laying off some of their employees. The rumors created uncertainty and disbelief in the company’s administration. Without the faith the employees, it is practically impossible for productivity to occur within the organization. Ultimately for these companies, employees were laid off but the issue that was present was the lack of trust the employees held in its administration due to the rumors.

It is evident that changes are not always accepted by employees as the administrators would like. Some change can awake fear in employees. A similar study by Fleisher (2011) discovered just that:

State budget cuts, job restructuring, employee buyouts, a shakeup in leadership and now the prospect of layoffs have all contributed to a general sense of uncertainty and, in many cases, fear among employees at the region’s largest health care provider. Employees interviewed for this article — both current and recently departed — say morale among DHMC staff is the lowest it has been in many years, even decades. Many former staffers, such as Diane and Roger Bruce, still have high regard for the institution and the more than 6,000 employees who work at the DHMC campus in Lebanon. But change is hard, they said, and particularly this year, change has come fast.

The severity of the medical center’s morale problem became evident last month, when a part-time licensed nursing assistant took her life shortly after learning that she had lost her job during the restructuring process. The suicide became a topic of conversation among many DHMC employees, some of whom attributed her death to her job loss, although those closest to her say a number of factors may have contributed to her despair. Employees who have recently taken early retirement offers, and some who still work at DHMC, say a cloud of uncertainty surrounds the organization. Most current employees spoke with the Valley News only on the condition of anonymity, despite assurances from DHMC officials that employees can speak openly without fear of retribution. The employees nevertheless fretted that their comments would be used against them in job evaluations, or even lead directly to their firing (Fleisher, 2011).

This particular study discovered that the loss of jobs impacted the employees in more ways than ever imagined. A young lady took her life after she was terminated from her position. This was one factor that was not considered by the administration. The negligence of upper management left a mark on the employee morale at DHMC that may not be repairable.  Also according to Fleisher (2011), “there has been a feeling for some time among lower-level employees that Dartmouth-Hitchcock was a top-heavy organization” (Fleisher, 2011); this implied that upper management being so heavy at the top of the chain affected everyone that fell below. One of the nurses at the medical center questioned why this organization would need so many administrators when this country only has one president and one vice president.

The next section by Fleisher titled “winning trust” involved strategies that management took after acknowledging that there were issues employee morale. The following information was found:

The organization began holding “town hall” meetings last year, during which employees could engage the leadership on topics of concern — the state budget impacts, early retirement, new initiatives, etc. During Weinstein’s first town hall meeting as CEO on Nov. 4, and in a subsequent email to staff, he emphasized the need for more transparency and encouraged employees to bring their concerns to him. “Rumors are natural, particularly when there is an absence of information,” Weinstein said. “I am committed to providing you with accurate and direct information on an ongoing basis, and pledge to do so now and in the future.” Weinstein then urged everyone to bring issues to department heads, or even email him directly. “He’s very much trying to engage the employees on what the issues are,” Adams said. “And how we can resolve the issues.” Improving transparency and trust would certainly be welcome among the majority of employees, said Bruce Kozlik, of Unity. Town hall meetings and emails from the chief are one way of doing that, but Kozlik said he felt some more face time with leadership would help, too (Fleisher, 2011).

The administration was able to recognize the changes that were needed and acted on this need. Even though there were many trials and tribulations that the medical center faced, there were ways to right all of their wrongs. The administration could never replace the life of the nursing assistant that committed suicide, but the efforts of rejuvenating employee morale and trust after tough times is truly commendable.

Patient Centered Medical Home Status

Bond Community has attempted to also rebuild its structure and gain employee trust by another common transition for health care centers. By definition, a patient centered medical home (PCMH) is a team based health care delivery model led by a physician, physician’s assistant, or a nurse practitioner that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. The ultimate goal for Bond Community is to provide all possible health care services for its patients all at one organization. Bond has prepped for this transition since 2011 with their implementation of electronic health records. Yes, the facility was required to embrace this change according to Leon County but the center had the PCMH goal in mind so the required change couldn’t have come at a better time. With Bond Community currently providing primary care, dental services, behavioral health, social services, community outreach, transportation and the addition of podiatry and chiropractic services, the Bond Community is very close to completing its qualification process for becoming a patient centered medical home model. PCMH eligibility requirements are displayed in Table 1.

Discussions

Change Management to Occur

There are a few simple steps that could produce effective change management for Bond Community Health Center. In order to achieve effective change management the organization must be thoughtful of its current staffing needs, become sensitive to their adjustments to change, and maintain an open dialogue to avoid as much resistance as possible. The staff must be involved in the changes mainly to have a sense of being needed and that their wellbeing is important to the administration. The most important investment a manager can make will always be with the people who help keep the organization running. Forcing change will result in unwanted problems and delays from staff. The change must be beneficial to the current needs of the organization. And most importantly the staff must have a sense of involvement in the change to help reinforce a receptive environment.

An example of change management for Bond could be compared to a road trip to New York. All parties choose to drive their own vehicles to get to the destination but ultimately intend on meeting at the same place. Everyone can start in front of the organization and all pull off at the same time but if the only information that the parties have is that they are heading to New York the chances of everyone making it to the same destination remains with the administration. The staff must be given a map of which roads to take and how the arrival will impact the individuals and the organization. The resistance to the changes are only present when individuals are unsure of how their personal lives are affected. Resistance in the form of being afraid of change is often seen especially when the organization has endured as many obstacles and as much media scrutiny as Bond has underwent.

Employee Interview. S. Jackson (personal interview, December 3, 2014), a Bond Community Health Center employee has fell victim to the management changes and the impact on employee morale. When asked what factors that she believe have influenced the decrease in employee morale and if she has been personally affected by these factors, she stated the following:

I honestly believe that because of the way employees are treated is a factor that plays in the decrease of employee morale.  When there is a layoff that is involved, and then you make employees reapply for the position that they already have and only hire back half of the staff, it makes administration look like they really don’t know what they are doing.  This will make employees lose the enthusiasm and drive that they once had for the organization.  Not to mention when there are extra duties that are piled upon one person and you aren’t being compensated for it, it can be stressful.  No one should be overworked and underpaid, especially when you know that there the department that the specific employee is understaffed.

The workload is already enough for them, yet more is being piled on just because administration is 1) not realizing that there needs to be someone hired to do the extra work so that the workflow can run smoothly or 2) they aren’t worried about hiring someone just because they know they can put it on someone else, not worry about how it is affecting that employee, and keep the money that is budgeted for that department and do whatever they want to with it.  Another factor that can have an influence on employee morale is continuously purchasing land/buildings with hopes of one day occupying them so that you can build up the organization and they aren’t being utilized at the moment.  When things like this happens, its shows employees that you aren’t investing wisely.  What’s the use in putting money into something that you know that you can’t afford at the time not to mention staff when you have let go quite a bit of your employees.  If you aren’t making sure that where you are is growing to where you have to expand out of where you are that’s like taking a bag of money and just throwing it away…it makes no sense!!  You have to be knowledgeable enough to know what good investment is and what isn’t. (Jackson, 2014)

The emotion expressed by this current employee is evidence of the influence that management changes have done on her situation alone. Even though historically the emotions were not an available topic of discussion in the place of work, these emotions will indeed effect performance.

Employee Emotions. The emotional state of the organizations employees will possibly be the determining factor of the organization winning or failing. From the research of Pervez (2010) found that:

Emotions are pure human psychological phenomena. An employee is critically affected by their behaviors in the workplace. An employee’s emotions and overall temperament have a significant impact on his job performance, decision making skills, team spirit, and leadership and turnover. What employees feel and how they express their emotions affects their performance. Emotions directly influence decision making, creativity and interpersonal relations (Pervez, 2010).

This research evaluated employee emotion and how it impacts performance and morale. Pervez later implied that these emotions are merely brief episodes of mind and body fluctuations. Ultimately, it is possible that the employer can maintain control of these episodes by being conscious of the impact of organizational changes.

 

The Need for Innovation. There are many older managers at Bond Community Health Center. The issues with this is some are resistant to change because of uncertainty of the changes benefiting their personal lives or interfering with their comfort. “Such resistance to change, types of change, and perspectives on the leadership and management of change and development, including organizational development, some analyses of successful leadership of change, and examples of successful and unsuccessful change leadership in public organizations” (Rainey 2010).

Management Roles. The motivation that the employee receives from management is important. Regardless of the circumstances that management or the organization as a whole may face, the employees as individuals have needs as well. According to A.H. Maslow (1943) “A Theory of Human Motivation”:

Any motivated behavior, either preparatory or consummatory, must be understood to be a channel through which many basic needs may be simultaneously expressed or satisfied. Typically an act has more than one motivation… motivation theory should be human centered rather than animal- centered (p.114). And that to say the person who thinks he is hungry may actually be seeking more for comfort, or dependence, than for vitamins or proteins (p.115)

Maslow points out that humans have a few basic needs and the most important in the case of Bond Community Health Center employees would be the safety needs. As stated by Maslow, “… the dominating goal is a strong determinant not only of his current world-outlook and philosophy but also of his philosophy of the future.”(p.117) Maslow explored the scenario of children and infants and their simple sense of needs. Infants and children do not possess reactions to fear because of the lack of experience. With adults, society has warped their minds with all possibilities and outcomes. The healthiest people are completely satisfied with the all of their basic needs and react in proportion to their satisfactions. The emotional state of the employees is impacted by the sense of safety in the organization. This is considered as the carrot-and- stick approach later discussed in the text by D.M. McGregor (p.156).

Douglas M. McGregor has made profound discoveries in the area of human enterprise. His beliefs that historical perceptions of man are insufficient to the man of today was proven to be correct. Organizational settings are crucial for human energy and outcomes. The governance of Bond Community Health Center during the earlier days were functioning on a Y Management Theory. But with the changes that have occurred over the years, the operating theory is now an X Management Theory. Management is now more than ever in charge of the motivation of the employees. The modification of their behavior and emotions are direct results of management modifications. According to McGregor (1957), “they must therefore be persuaded, rewarded, punished, controlled– their activities must be directed” (p.153). Immediate intervention was recommended by McGregor because people are not by nature resistant to the organizational changes or needs by nature. McGregor’s view on the human side of business in due course views theory X as being influenced by external determinants and theory Y as being measured by self-control and direction.

The theory of Herbert Simon (1946) could be used to compare the rational decisions and bounded rationality that the centers administration and board members are making. When the lives of so many, i.e. the employees and patients of Bond Community, that are at risk rational decision makers should be at the forefront to assist with span of control and maintaining the organizations actual purpose which is to serve the community. H. Simon found in Unity of Command: administrative efficiency is supposed to be enhanced by arranging the members of the organization in a determinate hierarchy of authority in order to preserve “unity of command” (p. 128). He also stated, “That purposes form a hierarchy, each sub-purpose contributing to some more final and comprehensive end, helps to make clear the relation between purpose and process” (p.133). Simon later implied that this unity of command can be seen in two different perspectives. One perspective is there should only be one person to possess the authority that the employee must obey to. There were scenarios at Bond Community where the employees had to face reprimand from multiple managers including the board members.

The next Classic theory is Dennis F. Thompson (1985) of “The Possibility of Administrative Ethics.” The administrative ethics comprise of the moral and principles in which the administration manages the organization. Traditionally, theorist looked at administration ethics in a general sense and not really for what it is. The fact that the author present is that to look at administration generally would be insufficient. And the insufficiency would rest with the fact that even though morals and principles are there doubt will always be present. Dennis (1985) stated that:

We should assume that the moral perspective can be vindicated and that some moral principles and some moral judgments are valid. Despite disagreement about how morality is to be justified and disagreement about its scope and content, we nevertheless share certain attitudes and beliefs to which we can appeal in criticizing or defending public actions and policies from a moral perspective. The more direct challenge to administrative ethics comes from those who admit that morality is perfectly possible in private life but deny that it is possible in organizational life (p.460).

When the organization was in its developmental process triumph was obvious and the administration and board members felt there was not a need to hound the staff on day-to-day operations. As the years went on the management style changed but there was still a lack internal auditing to ensure the originals policies that were set were in still effective and being put to use. Classic theories should not be neglected when it comes to correcting issues that today’s organizations are facing. These assumptions included in the Classics have also proven the belief that Bond Community is not the first organization to face difficulties but there is room for improvement.

Recommendations

Interview with the Competition

During anonymous interview process with an employee of Bond Community’s competition, effective leadership styles were discovered. This individual was asked to identify a leader and their role at their organization. She stated that:

The individual that I choose is my current Director. This individual is my organizations Director of Billing and Reimbursement. I am employed at a local Community Health Center and my Director is in charge of oversight of our patient and insurance reimbursements. The Community Health Center services Tallahassee and all surrounding counties. They offer services such as primary care, obstetrics and gynecology, dental, pediatrics, ophthalmology and podiatry. My Director manages a team of 7 people in 2 different departments. In the area of billing she supervises the reimbursement process from the patients that are serviced as well as their insurance companies. She is also there to make certain that the organizations policies and compliance standards are abided by.  My Director works closely with the organizations chief executive officer, chief operating officer, chief financial officer, and all of the other department manages to guarantee a cohesiveness within the organization (Anonymous, 2014)

She was also asked to identify the preferred leadership style that her identified leader uses. She then went on to state that:

It is impossible to identify only one leadership style that my Director uses. And I believe this plays a major factor in why she in fact an effective leader. My Director is a visionary in many ways. She is really good identifying a person’s passions and assigning task that will help build on that passion. A perfect example to her visionary skills is when she recruited me from a different department. All of the department heads have the ability to scout and recruit employees from different departments. I started with this organization doing insurance eligibility because the position paid more than my employer at that time and I was well experienced on the process. But after reviewing my resume again, the chief operating officer and my now Director felt that I would be better suited in the billing department. In this department I am able to work independently, supervise staff, and conduct interdepartmental meetings.

The second obvious leadership style that my Director possesses is pacesetting. In my opinion, when a person has too much of the visionary style they will run into the conflict of becoming a pacesetter. There are often times when she will trust the staff’s capabilities to execute certain task. With a staff of 7 people, our 2 departments often take on more assignments than we can handle. An example of this would be the county grant reporting that is done monthly. With the amount of information that is required by the county, this process requires a full time position. There is usually one person assigned to this task with a deadline that has to be met without exceptions. And that individuals “normal” daily task will still have to be completed and receiving help is not an option. This creates a negative climate within the departments because there are so many goals and deadlines to be met.

The final question was in the area of emotion, do you believe that the leader that you identified is an ideal leader?

Yes. The best example of her being perfect in her craft of being a leader was the support that she provided me one my grandmother passed. She understood my feelings, showed a lot of empathy, and took care of all my bereavement paper work. Her displaying these kind gestures showed me that she cared and that meant a lot to me at that time. One of the last things a person wants to feel while grieving is additional and unnecessary stress. I always believed that she was in tuned with her employees’ emotions and their best interest. But it is also obvious that she has a higher concern for task and productivity making her an autocratic leader.

Taking management advice from the organization in which Bond Community’s major source of funding was lost to is something to consider. This organization was once the underdog that developed a recognizable name. From the interview it is clear that the morale is high in that particular department. And the morality was established by the managers leadership styles and abilities.

One Minute Manager. The final recommendation suitable for this organization could come from the theories in The One Minute Manager. Blanchard and Johnson tell a story based around the concept of a one minute manager. Throughout the story the authors presented three secrets on how to become this ideal one minute manager:

1. The “first secret” is the one minute goal setting. With the first secret you must agree on the goals, identify the good behavior, write out the goals in less than 250 words, read and re-read the goals taking less than one minute, take a minute to look at your performance, and determine if your behavior aligns with your goals.

2. The “second secret” is the one minute praising. You must tell people up front on how they are doing, praise them immediately, identify what they did wrong, express how good you feel about what they did right, stop to let them know how you feel, encourage them to do more, and make contact by touching them to make your support clear.

3. The “third secret” is the one minute reprimand. With this last portion of the one minute manager you must make them aware that you will follow up on how they are doing, reprimand immediately, tell them specifically what they did wrong, express how you feel about what they did wrong, pause for a moment of silence so they can feel how you feel, then shake hands to reassure them you’re on their side, remind them of their value, reaffirm that you think well of them, and when the reprimand is over then that is the end of it.

The referenced “One Minute Manager” in the story was the epitome of a great leader. Every person that was interviewed by the story teller had the same sentiment of the manager. Even people in other organizations made attempts to replicate the techniques this manager.

 

Conclusion

In the essence, many organizations have faced challenges that impaired their abilities to fulfill the expectations of their employees. The concept of employee morale and emotion is overlooked and understated until it is lost. Emotional is intelligence is recognized by how the leaders conducts themselves and all interactions. Emotionally intelligent groups are really important in all group settings. The importance of this groups is to identify the task at hand and to build successful teams. Each team must have full participation, commitment, and cooperation from all members. And a positive sense of norms is important for the groups’ behavior.

The most important discovery from the research was to understand that the lost can be recovered. Recognizing the need for reestablishing employee morale is the first step and all other methods will follow. And even through changes of management, without high employee morale the organization will not survive. Helen Keller (n.d.) once said that, “The best and most beautiful things in the world cannot seen or even touched, they must be felt with the heart” (Keller, n.d.). Even though it is clear to visually see what caused the decrease in employee morale, it will take the heart of management to reverse the problem.

References

Alcock, A. (2013, August 8). Bond CHC Board Chair Won’t Resign. Retrieved from: http://www.wctv.tv/home/headlines/Proctor-Calls-On-Bond-Chairman-To-Step-Down-218835231.html

Alcock, A. (2013, September 23). Protesters Call for Bond’s CEO and Lawyer to Resign. Retrieved from: http://www.wctv.tv/home/headlines/Problematic-Lease-Deal-For-Bond-CHC-Specialty-Clinic-225096362.html

Anonymous (2014, December 1). Email Interview.

Bennett, L. (2012, May 8) CEO of Bond Community Health Center Arrested, Now on Paid Leave. Retrieved from: http://www.wctv.tv/news/floridanews/headlines/CEO_of_Bond_Clinic_Arrested_2_DUI_Arrest_150610905.html

Blachard, K., & Johnson, S. (1982), The One Minute Manager. (p.34, 44 &59)

Bond Fires Health Center CEO. (2014, September 30). The Tallahassee Democrat. Retrieved from: http://www.tallahassee.com/story/news/local/2014/10/29/bond-board-fires-health-center-ceo/18147423/

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Lancaster, J; Family & Community Health, 2007 Jul-Sep; 30 (3): 165. (journal article – editorial) ISSN: 0160-6379 CINAHL AN: 2009607290Subjects: Health Services Accessibility; Nursing CareDatabase: CINAHL Plus. Retrieved from: http://web.ebscohost.com.ezproxy.barry.edu/ehost/pdfviewer/pdfviewer?vid=3&sid=6731d43b-cc48-46a6-9d8a-ce3e21034f08%40sessionmgr13&hid=24

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Walsh, C., & GAZETTE, T. (2003, Feb 23). Workplace rumors fuel employee uncertainty/ doomsday forecasts shatter morale, trust. The Gazette Retrieved from http://ezproxy.barry.edu/login?url=http://search.proquest.com/docview/268237954?accountid=27715

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