Restructuring a Specialty Animal Hospital 1

Restructuring a Specialty Animal Hospital to Optimize Productivity by Applying Empirically

Supported Theories & Designs

Eric Foltrauer

Organizational Behavior, SUNY Farmingdale State College

Dr. Michael Goodstone

December 7, 2015
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I. Case

For 2 years, I’ve worked in the emergency room of a veterinary hospital run by an

association of specialists who head extensive, state-of-the-art departments—one of which holds

the only radiation treatment machine on Long Island that is used for animals. The Center for

Specialized Veterinary Care is owned and administrated by six advanced-degree holding

veterinary specialists who each come from different training.

History

The Center for Specialized Veterinary Care (CSVC) in Westbury, New York was

incorporated twenty-two years ago in 1993. The trend of hospitalizing animal companions has

substantially increased in America during the 1980s which saw a sudden increase in pet

ownership. The growth in demand for medical pet services emerged in a vacuum on Long Island.

Suburban families, which highly populate the region, consider buying or rescuing a pet when

they have expendable income. There existed primary care veterinary offices within and among

the communities of Long Island. There was however not a sufficient supply of advanced care for

beloved pets, or animal companions. Critical and peculiar problems can only be remedied by

veterinary facilities that specialize in areas such as emergency and intensive care, dermatology,

oncology, cardiology, neurology and neurosurgery, radiology and imaging, surgery, internal

medicine, hyperbaric oxygen treatment, and alternative medicine that includes utilizing Chinese

herbs as treatments. After its inception, other specialty hospitals in the local region were

established.
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The emergency room of the facility is also designated as the intensive care unit which

houses animal-patients that are in danger of acute, deteriorative relapses from their presented

chronic or acute states or ‘primary problems’ that is, their reason for inpatient stay. Although the

entire hospital requires intervention, for the purposes of this article, only one department, the ER,

will be used as an example that can be carried on to the rest of the organization.

Problem

Protocol is a very frequently heard word on any given day at the hospital. It refers to the

way in which every work-related task should be done according to those in charge, the executive

doctors. Proper protocol takes into account everything from the organization of clinical areas

such as the crash carts, procedure tables, counter and drawer space, the proper usage of blood

machines, handling of medical equipment such as oxygen tanks, sleeping gas masks, pulse-Ox

machines, the management of medical records, and step-by-step medical procedure instructions.

From the simple stocking and organization of supplies to the delicate techniques used for clinical

procedures, all protocol is subject to change and some of it changes with great frequency.

CSVC considers the education of its staff a very high priority. Teaching is taken very

seriously by the managing technicians who are in charge of all the workers of a given department

but the specialists do not successfully explain and implement new standards and practices.

Change here currently starts at the top, with those who make decisions, and are sent down to

employees who actually do the majority of the work. Since the specialists are overworked, they

do not have the chance to show how to use the new pulse-Ox machine, for example, which reads
Restructuring a Specialty Animal Hospital 4

how much oxygen is in the blood of a patient or, explain the new series of blood tests that will be

routinely used.

The usual route for communicating change is by writing emailed memos. They have

instructions to be read and understood by everyone. Recipients must then respond to the doctor

who sent the memo and say whether or not they comprehend the new change. The doctors, who

each run a department, have the least time of anyone to be making sure people understand how to

conduct a physical process that has been relayed via written words.

The departmentalization of jobs has created walls blocking satisfactory information.

Since the departments were made based on the function of specific jobs, employees with the

same skills were placed together; working together as a group dissociated from the rest of the

organization.

The dedication to the chains of demand—i.e., the line of reporting to specific individuals

based on authority—are very high. There are multiple chains of command at the hospital; one in

each department. The unity of command, or the prevalence to only report to one superior, is

strong in every department. The span of control, or the quantity of subordinates that can be

directed well, for each manager is small. There are too many managers. Some of them do

redundant work, like scheduling, resulting in frustrated employees and beleaguered managers.

Since all of the decision making at the organization is centralized, employees performing

small but necessary tasks get little say in making the processes more efficient. This leads to a

great sense of disconnection for the lowest employees.

The bureaucratic structure makes very rigid regulations and procedures, centralized

authority, detached departments, constricted spans of control, little communication, feedback and

change, and a single route of decision making within each department. Since factors in avant-
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garde medicine cannot flourish with the typical standardizations applied to organizations, the

hospital should be made less standardized. Innovation departments like Respiratory Therapy and

Hyperbaric Oxygen Therapy can be quite variant, they need different measures and space for

creativity. The new respiratory treatments become popular often, the hospital has not been

keeping up with the recent trends.

II. Diagnosis

The problems of the organization are largely a result of an inorganic, ill-conceived

structure that was thought to be sufficient by the founders of the company. The problems begin

with the lack of communication from the top. Doctors cannot tell their staffers every new piece

of information. The hierarchical aspects of the structure result in subordinates not being made

aware of updates relevant to them that are not recognized as important by the doctors who first

find out about the changes. This leads to the doctors forgetting to mention these less pertinent

updates that involve the responsibilities of subordinates. The bureaucratic aspects of the structure

result in the implementation of changes that make some work more difficult. This is because the

employees who actually conduct the procedures were not asked how such procedures can be

improved. Those mandating changes have no familiarity with the actual proceedings of most of

the work done by assistants and technicians.

The current, rudimentary communication system is unsatisfactory. Hierarchical structure

is imprinted in scientific history as the convention the global medical community uses to conduct

training and practice. Specialists with the most experience train interns, those who are learning.

Their medical opinions are superior to those had by doctors with less practice. Thus, hospitals
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are run in a chain fashion. At the top, there’s the specialists. Next is the managing technicians

who run the work done in their respective departments. Everyone is commanded in a downward

fashion, giving an air of certainty to all work commanded. But when doctors delegate explaining

new protocol, certainty becomes compromised.

This hierarchical structure the hospital has is ineffective vestige of earlier organizational

models. It is no longer useful in the new environment because doctors are spending less time

with subordinates than they used to, and the majority of protocol updates do not pertain to

clinical procedures that are strictly conducted by medical specialists. The following

communication failures that result include opinionated argument driven by the fear of conducting

a task in a way not condoned by official updates. Occasionally, arguments ensue in critical

emergency situations that do not come with ample time. Eventually there are two versions of the

same process or procedure taking place at the hospital, one official and one outdated.

Currently, the specialists make all the decisions regardless of how mundane the issue may

be (see Figure 1 below). Then, as mentioned earlier, they send memos, receive responses, and

expect everyone to be well-informed. The specialists are overburdened by the requests they get

to better show workers how to do something new.

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Unplanned teamwork is starting to happen at CSVC. Workers from different departments

are informally communicating with each other to teach what has been overlooked by upper

management. These teams are mostly defined by position. Assistants are discussing protocol

updates together, as are technicians and managers. Nearly all of the staff at CSVC have high

personal motivation (they take their work personally). They are professional, accomplished,
Restructuring a Specialty Animal Hospital 8

motivated, discerning individuals from all breadth of training in canine and feline veterinary

health. But they are being hindered by a flurry of contradictive opinions and hearsay which

causes uncertainty in the conduction of relevant procedures and anxious discussion in emergency

situations in employees argue about best practice and consequences of subpar practice.

III. Organizational Theories

Very involved leaders who try to make sure every employee is aligned with new changes

being made, or taking place, in an organization are referred to as transformational leaders. Joris

van der Voet found that transformational leaders are essential to emergent change—that is,

change that organically occurs. So, if a new structure is emerging, having an interpersonally

skilled leader already familiar with the operations of the hospital will be necessary to make

changes as seamlessly as possible (2014).

IV. Intervention

The hospital will function more seamlessly with interlayered teams, teams composed of

individuals from each department who can bring complementary knowledge in problem-solving

situations. The task of restructuring an organization should be organized into three phases, each

with multiple tasks. In phase one, the project must be organized, parameters must be decided,

and the state of the organization as it presently stands must be assessed. Decentralization and

defining clear responsibilities are the main themes of the first phase (Recardo & Heather 2013).
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Positions in the organization should be filled based on competency and not by

incumbency (Recardo & Heather 2013). Assistants will discuss and learn, together, the new

processes presented in memos. Technicians will do the same as well as managers and specialists.

Then a representative of each position-based group will be part of team composed of a specialist,

a managing technician, a non-managing technician, and an assistant (see Figure 2 on the next

page). The representatives should be decided by recognizing then officially installing those who

naturally emerge as leaders in the process (Voet 2014). Teams will focus on one aspect of

hospital care like emergency procedures, non-emergency procedures, patient comfort, blood
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10
machine scheduling, etc. The representative will then dispense the official protocol along with

supplementary knowledge and opinions discussed by the respective team.

The teams will have a fairly high authority and report only to the liaison who represents

them. Spans of control should be maximized and the team making the restructuring decisions

should be made up of a diverse group (Recardo & Heather 2013). No longer will each

department head, manager, and room leader have to make sure everyone under him or her has

been properly briefed and taught about updated protocol. This division of labor will free up time

for maximal clinical work. The managerial hierarchy already in place will be functioning

alongside the team-based network to do its job as originally entrusted, but now with less

distraction. The position-based groups will hold workshops to demonstrate new protocol,

techniques, procedures, and allow for discussion and answering relevant questions. They need to

revisit the topic semi-regularly to review the progress of the updated protocol. If the organization

were to implement this, executive doctors, upper management, and room leaders would be able

to free-up much of their time.

Medicine is continuously improving thus changing. These veterinarians who welcome

challenges and want to stay at the top of animal care in the whole of the United States are

motivated to be ahead of the trends. Also, procedures and instruments improve for the purposes

of effectiveness. Developed updates by the executive doctors include some of the most important

skills the hospital utilizes.

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References

Joris van der Voet (2014). The effectiveness and specificity of change management in a public

organization: Transformational leadership and a bureaucratic organizational structure.

European Management Journal, Vol. 32 Issue 3, June 2014, 373-382.

Recardo R.J., & Heather, K. (2013). Ten Best Practices for Restructuring the Organization.

Global Business & Organizational Excellence, Vol. 32 Issue 2, 23-37.