Montefiore Hospital Case Review

1 EXECUTIVE SUMMARY

After reviewing the Montefiore Hospital Case, it is evident that this organisation started a journey of changes, however this was not effectively done. The purpose of this report is to highlight the major problems in light of the organisations inability to transform and change to an effective and efficient program management system.

The problems identified in the case were broken up into 5 main reasons:

* No Reporting Line Structure

* Ineffective Strategic Plan

* Dearth of Communication

* Lack of proper planning

* No commitment to Continuous Improvement

The underlying causes to these problems are explained in detail under each category.

1.1 Recommendations

* Do a SWOT and GAP analysis

* Make sure that lower management understand the organisations strategy and how it should be delivered. Align the objectives of the people to the strategy of the organization.

* The vision and mission of this organisation must be clearly communicated, shared and understood by all the levels in the organisation.

* The organisation should follow a policy to ensure upgrading of technology and systems. Also introduce a review process for all staff.

1.2 Conclusion

The foundation of effective balance scorecard programme management is the implementation of a matrix structure to create synergy through shared responsibility between project and functional management. The need for a more structured approach for the balanced scorecard programme management has been identified and addressing the need and making it happen now depends on executive and top management. The long term view is aimed at aligning all project and programme efforts into a fully functional programme office.

2 CRITIQUE ON THE MONTEFIORE HOSPITAL CASE.

It is evident from the case study that the senior vice president, Eliane Brennan, implemented huge changes. She changed the organisation from functional silos to a decentralised organisation. Elaine Brennan formulated a new strategy without sharing it first with the organisation and staff. No evidence exist that Human Resource were involved in all of these major changes. The Organisations Balanced Scorecard lacks talent management, staff training and a performance development process. No programme office was established and no Programme Manager appointed to manage and implement all of the changes made. The following problems were identified:

2.1 No Reporting Line Structure

Elaine Brennan introduced major changes to this organisation without establishing a Programme Office. Certain functions and responsibilities were allocated to nurses and physicians, including revenue, cost, quality, service, work environment and employees. Elaine Brennan was involved in all the changes and decisions and no evidence of a reporting line structure.

2.2 Ineffective Strategic Plan

Elaine Brennan participated in a planning process at the medical centre to formulate a new strategy for the Hospital. Nowhere is it stated that the resources of the organisation was informed of the formulation for the strategy, as the organisation must decide what needs to be done in order to achieve their strategic goals. There must also be a clear understanding of how strategy is to be delivered via the organisations processes. All the people of the organisation must clearly understand the vision and mission of the organisation.

Not all of the five key elements to strategy (what, how, why, where and when) reflects in the organisations balanced scorecard. Talent Management, staff training and performance development reviews are not included. The objectives of the people are also not linked to this new strategy, as most of the measures seems to be operational (improving cost, quality and timelines)

2.3 Dearth of Communication

No communication took place between Elaine Brennan and the rest of the staff and other departments at Montefiore Hospital. Strategy was changed without including a bottom-up participation process. The vision and mission of the organisation was never shared with all involved. Changes took place without following the proper communication channels. Informal meetings took place with two or three representatives from other departments.

2.4 Lack of proper planning

No evidence of proper planning reflects in this organisation, which resulted in the following:

* No interpretation of the organisations vision and mission and no alignment to the organisational goals.

* No performance appraisal system in place

* The project objectives are not aligned to the company strategy

* The completion of a feasibility study which will be depict the changes of success of the project

2.5 No commitment to Continuous Improvement

It is stated in the case that Elaine Brennan was faced with the problem of how to measure performance, as 90% of the hospital's measurements were financial. Other measurements focussed on operational aspects. Surveys were conducted to establish what contributed to a referring physician's hospital choice.

No indication that continuous improvement programme were implemented afterwards.

3 RECOMMENDATIONS TO SOLVE THE PROBLEMS

3.1 Utilize the Balance Scorecard approach to initiate change

To create change a top-down and bottom-up approach must be followed and the exercise must involve people at all levels of the organisation. Utilize the balanced scorecard to revise the following, remembering that all stakeholders need to be involved to again translate the company's vision/mission into desired objectives and performance measures that can be quantified and appraised. The balanced scorecard must also define

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