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ORGANIZATIONAL DESIGN FRAMEWORK THE TRANSFORMATION MODEL The Transformation Model is the framework we use to help leaders understand

d their organizations and also guide a successful redesign. The model reduces the complexity of an organization to eight key variables that must be understood and aligned for a business to be successful. Alignment implies a holistic or systems point of view that finds the best fit between all organizational elements. Paying attention to and understanding these variables will result in major improvements in customer service, quality, efficiency, cycle time, profitability and satisfaction of employees.

These eight variables form the big picture or context of an organization and ultimately determine its success. When we talk about organization design we are talking about the relationship and balance between each of these variables. The role of leaders could be defined as understanding and managing these variables. Environment. Organizations, like all living systems, can survive only to the extent that they maintain harmony with their external environment. This includes being sensitive to the evolving needs and perceptions of customers, understanding changes occurring in technologies, knowing your competition and understanding the legal, social and political climates. Most organizations eventually die because they fail to maintain a responsive attitude towards their environment. Strategy. There are two parts to strategy. Business strategy is a set of conscious decisions about how the organization will add value to customers and distinguish itself from its competitors. It also includes performance targets and strategy for growth. A well developed business strategy tells the organization where it is going and guides it like a ships rudder in a stormy sea. An Organization strategy is the being or character of the organization. It has to do with who we are and not just what we do. It includes the mission, vision of the future, values and guiding principles. A clear organizational strategy helps transform a company or office from a normal work place to one that inspires people and brings out their best. Core Process. This is the flow of work through the organization. It is the sequence of events or steps necessary to get a product out the door or deliver a service. This also includes the technology and

resources (equipment, software, space and materials) required to produce a deliverable. Core business processes are, or should be, the focal point around which all other business unit activity is organized. Understanding, streamlining and properly supporting core business processes is the central job of any organization. Structure. How people are organized around business processes. It moves beyond box charts to understanding the boundaries, roles, responsibilities and reporting relationships among people. It is a sort of template that determines not only relationships but coordination of tasks and allocation of resources around business processes. The proper question about structure is not whether it is the right one, but whether it fits with the rest of the organization (core process, strategy) and helps rather than hinders performance. Systems. Systems are the inter-related sets of tasks or activities that help organize and coordinate work. Examples include recruiting and selection, training and development, how people are promoted, communication/ information sharing, decision making, how people are rewarded, planning/ goal setting, personnel policies and procedures, performance feedback, etc. Systems are usually standardized and cut across the whole organization. They are often owned by management or special support functions. The most effective systems are often the simplest. Culture. Culture is how the organization really operates. It consists of the leadership style, worker attitudes and habits and management practices that make up the distinctive personality of the organization. It is like the air that permeates everything and is both cause and effect of organization behavior. Culture mirrors the true philosophy and values that the organization actually practices. As such, it is a measure of how well an organization has translated its philosophy (organizational strategy) into practice. Results. What is the organizations current performance? Results define the success or health of an organization and are therefore the starting point for understanding how well the organization is functioning. Results indicate where the organization is strong and what it needs to keep doing, as well as where it is weak and what it needs to change. Everything is tied to results. Not being clear about current or future results is like being lost at sea; even knowing where you want to go, you dont know how to get there. Leadership. Leaders drive success. They set goals and monitor results, scan the external environment, define vision and strategy, design (consciously or by default) the infrastructure of the organization, develop people and build culture. However, traditional assumptions, roles and practices of leadership are no longer adequate to manage in todays complex world. Successful leaders are changing their assumptions about work, organizations and people to build collaborative, more responsive organizations.

Overview As the world of health care continues to evolve, those responsible for providing care must look at their roles and practices, and evaluate themselves against the needs and demands of the health care system of the future. This system of the future will require significantly more involvement on the part of consumers, and will operate in an environment that demands a relentless focus on reducing costs, improving quality and access to care, and improving the perceived satisfaction of both patients and caregivers. It will require those who deliver care to focus on developing innovative ways of providing this care. An organizational approach to learning and development, with a focus on innovation and creativity will become essential. To meet these goals for health care, we must focus on the professional development of leaders and staff members, their ability to continually reinvent their approach to providing care, and developing their skills to support the attainment of the organizations goals. The Transformational Model for Professional Practice in Health Care Organizations was developed as a "framework" for that purpose. It is a descriptive picture of the factors necessary to support professional practice and patient care, the processes necessary to meet the challenges of tomorrows health care systems, and the outcomes that can be anticipated. The Transformational Model is divided into four components. In the Professional Practice Component, assessment and activation of professional practice relationships and support occur. In the Process Component, there is engagement in purposeful and deliberate critical thinking, negotiation, and decision making which brings together (1) the unique needs of each patient, (2) professional recommendations, and (3) effective resource management. This results in attainment of targeted goals, or Primary Outcomes, which enhance quality care, patient satisfaction and caregiver satisfaction; and Strategic Outcomes of consumer, organizational and professional health. The Transformational Model is applicable to any health care organization or system. The concepts can be "customized" to a specific organization or system based on that organizations vision, values, goals and intended outcomes. This model can provide the framework for developing a plan for integrating a health care system, balancing competing priorities, developing and maintaining a cultural identity, developing leaders and staff, and maintaining an unerring focus on the organizations values and goals.

The Transformational Model

The Professional Practice Component

The inner core of the Professional Practice Component contains the heart of the model. This core reflects the unique contribution each clinical discipline brings in caring for a patient. In times of transformation and limited resources, it is critical that each clinical discipline carefully analyze its practice to eliminate elements that do not add demonstrated value to patient outcomes. Those elements remaining must be carefully protected and supported. This support is provided through the 20 concepts surrounding the core. These concepts are divided into four sections: Transformational Leadership Care Delivery Systems Professional Growth Collaborative Practice

The Process Component

The Process Component is intended to reflect the processes used by professionals in caring for patients. In a transformed health care environment, "routines" of care that do not add value to patient care need to be abandoned. Care requirements will be negotiated between the patient and caregivers, resulting in highly individualized goals. Once these goals are determined, the mutually established plan of care will be purposeful, reflect the uniqueness of the patient, be sensitive to the availability of resources, and be targeted directly to the desired outcomes.

The Primary Outcome Component

The Primary Outcomes related to the patient include the level of:

Satisfaction with the quality of care received and accessibility of care. Congruence between the patient and caregiver in determining health care needs, and prioritizing health care services and activities. Responsiveness to patients needs (as perceived by the patient). Participation in planning and executing care.

The Primary Outcomes related to the Health Care Team include: A dynamic work environment that is supportive of high performance behaviors. The transformational quality of professional relationships. The voice and power of caregivers to contribute to the goals of the organization. The support available for personal and professional growth.

The Strategic Outcome Component

The Strategic Outcomes related to consumers include: The willingness of consumers (patients, caregivers, third-party payors, etc.) to promote and or engage in future relationships with the organization

The Strategic Outcomes related to the organization include: The increased ability to respond flexibly to the dynamic changes in health care. The increased ability to position itself to compete financially in the health care market. An enhanced reputation for the provision of quality care.

The Strategic Outcomes related to the profession include:

The ability of the members of the organization to influence the direction and growth of individual members of the organization, as well as the professional organizations to which they belong. The ability of the members of the organization to influence the direction and growth of the professional disciplines (medicine, nursing, pharmacy, social services, etc.) through educational offerings, professional publications, and research contributions. The willingness of the organization to invest in the future direction of the professional disciplines.

Implementation of the Model The concepts within the four sections of the Professional Practice Component will be operationalized differently depending on the organizations developmental level. Using an adjunct model developed by Nelson and Burns, organizations can be categorized into four levels: reactive, responsive, proactive, and high performing. At the reactive level, there is often both a crisis mentality, and minimal teamwork. Personnel are focused on "survival," and are often paranoid, pessimistic, and distrustful. At the responsive level, staff are cohesive and focused on achieving near-term goals. They are able to handle problems appropriately and effectively. The proactive level builds on the responsive level and expands it. At this level, the future is seen as a choice to be made, not something with which one must cope. Strong shared vision and values serve as a compelling force for actions which prepare for that future. Continuing to build on the proactive level, the high performing level emerges. There is a high level of synergy, energy, spirit, and creativity that results in a superior level of performance. The following grids reflect on each of the concepts in the Professional Practice Component at a reactive, responsive, proactive, and high performance level. These grids can be used for an organizational, departmental, or individual assessment. They can also serve as a "road map" to guide organizational development. Transformational Leadership Care Delivery Systems Collaborative Practice Professional Growth

Applications of the Model

The Transformational Model for Professional Practice can provide the framework for your: system/organizational statements of mission, philosophy, and goals strategic planning operational planning outcomes management system and organizational management plans committee/support structures recruitment orientation and continuing education role descriptions and evaluation tools leadership development staff development research applications