Nikita Zislins

To begin with, I want to say hello, my name is Nikita Zyslin. And first of
all I want to discuss shortly what is the case "Barbara Norris: Leading Change
in the General Surgery Unit" about. The case is about a woman who started
work as an ordinary nurse, then he decided to stop working to take care of her
family. After returning to work soon after she had the opportunity to take the
place of a nurse manager . Barbara did not seek to earn more money, she
considered this position as a challenge to herself, although her friend Betty
dissuaded her from this decision, but Barbara still decided to become a manager
but did not take into account some of the pitfalls that awaited her. Ando also a
crisis has began, because of which the hospital could not pay overtime to
employees.
Noting the main problems described in the case, we can say that this is
the lack of teamwork, lack of respect for each other, lack of bonuses for the best
employees and lack of mutual assistance.
Starting to analyze this case, I want to notice one small detail about which
not much has been said. In my opinion, the director himself should also have
advised Barbara and warned her about the situation in the hospital. And in the
text, I noticed one small detail. It seems to me that the director himself, whose
name is John Frappewell, treats Barbara without any respect, I made this
conclusion based on how John spoke to Barbara and by calling not her full
name, but simply Barb, when it is seeable that all her friends and colleagues call
her by full name. This may also indicate that the director himself is not
interested in solving problems and for him Barbara is just a person who will try
to solve hospital problems.
Next, I want to discuss the organizational structure, as well as how the
work of the entire team is arranged. To do this, I will refer to the theory that was
told to us at the lecture. First, Barbara should make an Employee Group so she
can classify the nurses into several categories. Expert, senior, specialists and
junior specialists. This will enable staff to understand who they should contact
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for help, for example if a senior nurse has questions she can ask an expert for
help, and also it will make them better understand their responsibilities. Also a
very important part of the workplace is organizational structure, at the moment,
as we can see in the hospital there is Flat Organizational Structure, and it seems
to me that this is wrong, in this case, Barbara's job is to help each employee by
herslef, my decision is that Barbara should remake the organizational structure
into a Matrix, appointing 3 other functional managers who will be nurses with
the highest experience, and already each functional manager will have the
responsibility of helping and supervising the work of other employees in every
aspect. This will take the load off from Barbara and also create a career ladder
that will also give motivation to employees to become better. Barbara should
also understand that the work of the entire team is based on the principle of Jay
Galbraith Star Model. Where employees build a strategy due to which a
structure is built, followed by processes at work, and only after that follows a
reward and at the same time everything is interconnected. Thanks to sustainable
organizational design, it will be possible to achieve goals

1. Could she talk to her director of nurses and seek a

reprieve from the hiring freeze and get more staff for
GSU?
Let's move on to the first question of whether she can get her director to
hire more staff for the General Surgery Unit. Referring to what I said, Barbara is
unlikely to be able to get more staff, for the reason that, as already mentioned in
the text, at the moment there is a crisis, and the hospital is not able to pay even
more staff, as well as director doesn’t treat Barbara’s idea. Analyzing the case,
one can understand that there are not enough employees, as well as there is not
enough budget in order to pay for overwork. It seems to me that to solve this
problem we need to calculate a coefficient called the bed occupancy rate

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(BOR). By calculating it, Barbara as a manager will be able to understand how

often the beds are occupied, this will help to understand how many beds should
be left in the hospital, because in my opinion reducing the number of beds
would allow employees not to take overtime, which in turn would attract new
employees because for the lack of a huge workload, as well as reducing the
number of beds would help reduce costs. It should also be understood that with
an increase in the number of beds, the cost of paying salaries grows faster.
According to Definitive Healthcare, the average salary per year for staff with 25
beds is $14 million, increasing the number of beds by 10 to 250 would increase
costs by 20 times to $280 million per year.
2. Would regular unit meetings build community and a
healthier culture on the unit?

Now the second question, the essence of it is whether regular meetings

can help unite the team. I think this is a great idea, because nurses will better
understand each other, as well as speak out all the negative which they
accumulated in the workplace. Thanks to this, the team will also be able to
make collective decisions, thanks to which it will be better for everyone. At
first, it will not be easy for nurses, as their free time will be spent on meeting
with the team and discussing their problems. But I want to say that complexity
is, on the contrary, very good in team building. Only by going through
difficulties with the team, the teamwork can be reached. I want to support my
opinion with the book “The Fifth Discipline” By Peter Senge. The main idea of
the book is exactly that the easy way out usually leads back in. I also want to
add that Barbara should use psychological tricks to find a common language
with the staff. Very often, employees are afraid to talk to managers, thinking
that managers will not like their questions, so I want to give an example of a
psychological trick described in Eric Berne's book "What Do You Say After

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You Say Hello?" by Eric Bern. Namely, Barbara should sometimes ask
questions to employees that are as simple as possible so that employees begin to
feel more free in the workplace, and they themselves are not afraid to ask
questions to each other.
Also, for better team building, Barbara should use one of the Job Design
Techniques, such as having the team do one big job together, such as deciding
how to allocate the budget. This is a difficult task that is extremely difficult to
do alone without the opinion of others, working in teams they will be able to
unite even more.

3.

The third question is how Barbara could thank the nurses for a job well
done. One of the nurses said that she did not receive any cash bonuses or verbal
praise, which suggests that Barbara should start giving verbal praise to the
nurses. Also, in my opinion, it is worth arranging a feast once a month only for
those nurses who have shown themselves well in a month. For example, every
month Barbara will choose 5 nurses who have shown themselves well at work
and invite them to a café or a feast. According to BestColleges.com, the average
salary of a manager in a hospital is about $80,000 per year, that is, about $7,000
per month, one feast for 6 people including Barbara will cost about $300, but
this $300 can improve the work of the team in several ways. Firstly, the
employees will be pleased that their manager invites them to a feast, based on
Eric Berne's book, the nurses will begin to feel special, thereby trying to get
better and better every day. Second, nurses may start hoping for a pay raise after
the crisis is over, which will also give them the motivation to work better.
Thirdly, posting photos from feasts on social networks can potentially attract
new employees, since when they see how well the employees in Barbara's
department are treated, they will want to get a job there as well. Yes, this is
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Barbara’s personal money, not the hospital’s budget, but these 300 dollars will
also make Barbara’s work easier, she won’t have to worry that her employees
will leave her, thereby she will solve a lot of problems, which will soon put her
in the best in the world in front of the director.