Yorkshire General Hospital Healthcare and Hospitality Case Study

Yorkshire General Hospital

Professor Nkiru Nelis became the CEO of Yorkshire General Hospital in July 2017. It was a challenging time in the health care industry and particularly in the suburbs of Atlanta. The challenges were also exciting, and the leadership team was willing and able to analyse the situation and create a direction for the hospital. But where and how? The leadership team faced various challenges and were not immediately sure how they might be solved. The changes necessary to be competitive improving facilities and technology would involve millions of dollars in outlays.

But Yorkshire General did not have millions of dollars for such investment.

Yorkshire General Hospital is a large community hospital (333 beds) located in the western suburbs of Atlanta in Polk County, Georgia. The hospital has a workforce of 1,600 employees referred to as associates and 500 volunteers. There are 900 members of the medical staff. Most of the physicians have their own practices and are simply qualified to practice at the hospital (a situation called residency). Only a few of the physicians are direct employees of the hospital. Many of the independent physicians have residency at other hospitals as well and will encourage their patients to go to any of the hospitals at which they have residency.

Yorkshire General Hospital is a not-for-profit organization and a member of the Lancaster Health Care System, the second largest health system in Georgia with eight hospitals and 20,000 associates. Yorkshire General has inpatient, outpatient, and emergency services in a broad spectrum of health care specialties, which serve the surrounding communities. The main services offered by Yorkshire General are general medicine, surgery, cardiac medicine, and women’s & neonatal care in addition to diagnostic services (e.g., lab, x-ray) across all main medical areas.

Lancaster Health Care System is the parent organization of Yorkshire General. Lancaster approves Yorkshire General budgets and is the primary funding source, with the Yorkshire General Foundation the other.

Professor Nelis knew Yorkshire General was a good hospital when she became the CEO in 2017. But as she started collecting some of the data, it became clear that the hospital was not realizing the potential that she thought it had. Nelis determined the requirements of Yorkshire General stakeholders. For inpatients, outpatients, and emergency department patients, the key requirements were high-quality and safe care, friendly staff, prompt service, and the need to inform and involve the patients and their families in care decisions. Associates (the workforce) required fulfilling work, a caring patient environment, a commitment to quality, confidence in senior leaders, and to be treated with respect. Physicians required quality and consistent nursing care, patient safety, quality administration skill, and efficient operations. Other stakeholders, such as government agencies and regulatory bodies, wanted efficiency and high-quality care. The community required access to high-quality care.

The Situation at Yorkshire General

As CEO Nelis entered the strategic planning process in July 2018, she concluded the following:

• Clinical quality was generally perceived as good, but not exceptional, except for the cardiology and cardiovascular surgery department.
• Patient satisfaction ranged from mediocre to poor with outpatient satisfaction at the 18th percentile and inpatient satisfaction at the 26th
  percentile compared with relevant data from surveys.
• The level of nursing care was “uneven.” The competency and consistency of nursing care varied from days to nights, units to units, and weekdays to weekends.
• Physician satisfaction with hospital services was mixed and physician views of the Yorkshire General leadership ranged from ambivalent to
  untrusting and adversarial.
• The medical staff included mostly highly experienced physicians; however, most physicians had residency at other hospitals as well. This
  meant that these specialists could choose to recommend that their patients go to another hospital for their inpatient or outpatient procedures. Furthermore, physicians felt undervalued by the leaders of their respective specialties.
• Associate (workforce) satisfaction was at the 46th percentile compared with the national norms and there were numerous vacancies in several high-skilled positions.
• Facilities and technology were perceived as being behind the competition in the region. Except for the six beds in the paediatrics unit, Yorkshire General had no private rooms in a market where private rooms were quickly becoming the standard. Radiology equipment was old, and the catheter lab equipment was “fully depreciated.”
• Financially, the Yorkshire General net income of USD 14 million was lower than other hospitals in the market. In addition, Yorkshire General competed for limited available capital with the other 11 hospitals within the Lancaster Health Care System. On the other hand, competitor hospitals were able to invest all their financial resources into maintaining, improving, and expanding their facilities, clinical specialties, and workforces.

The challenges faced by the Yorkshire General leadership team were simple; the solution or solutions, however, were much more difficult to map out. The Yorkshire General competition was spending on facilities and programs that Lancaster could not afford to undertake right now due to limited resources and focus on hospitals with more immediate and critical problems. Yet Yorkshire General had to find a way to stay competitive in order to survive in the long term. CEO Nelis is worried. She calls a meeting of her senior management team to discuss the way forward in the light of a seven step plan her team has prepared.

1. Create a vision that will create personal responsibility and ownership.
2. Create an environment to create an improvement focus on meeting customer needs.
3. Create an evidenced-based mentality to help make well-reasoned changes.
4. Improve employee understanding of what is important to physicians and make changes to meet their needs.
5. Create a focus on processes to understand better ways of accomplishing tasks and to understand how elements in the organization relate.
6. Improve the leadership process and how each employee is a leader.
7. Deploy processes to create an improvement focus for all employees.

To ensure that the top management achieves success, you are expected to produce a report. In this report you will be required to evidence the following with reference to the Seven-Step Transformation Process above:

1: Evaluate and recommend a model of change that might be utilised in order to develop an environment that would allow the organisation to be competitive. 

2: Analyse what might be the major resistance from employees on the recommendations made above and, using appropriate change models and interventions, how might the CEO mitigate this employee resistance?

1. Explore and critically appraise strategies and methods used for the planning and management of change
2. Develop a plan to effectively manage a specified change.

This case study centres on the general manager (GM) of a small, 49-room Inn’s Restaurant located in a small seaside town not far from London. The majority of the Inn’s guests are locals and summer tourists.

The Inn’s new GM began his employment in June of the current year with a major goal of enhancing the revenue of the Inn, which was badly needed.

The Inn hardly broke even and the CEO and stakeholders were very concerned. Hence, a new GM was hired. Unlike the previous GM, who had over 30 years of experience in hospitality management. the new GM was a hospitality college graduate.

The Challenge for Yorkshire General

With his fresh perspective, he saw that the restaurant was consistently successful regarding special occasion dining. However, he saw a need for development of special dining opportunities on public holidays: Bank Holidays including Christmas.

The implementation of these public holiday dining opportunities, with proper marketing, could result in additional revenue as well as generate positive publicity within the community for the restaurant.

To the new GM it seemed only fitting for the Inn’s Restaurant which was known throughout the community for special event dining. He knew that with the right advertising and employee support, these occasions could prove significant for the restaurant’s annual revenue. He was also aware that only one other local restaurant of the same calibre as the Inn’s Restaurant was not open which meant that his property would be providing a service that was rare on these occasions.

The ultimate goal would be to provide a memorable special occasion dining experience in relation to the holidays, supplying the staff with extra tips and earnings, and generating more business for the restaurant, which would in turn entice repeat business and positive word-of-mouth to bring in additional customers.

The new holiday dining options would improve the restaurant’s reputation for special occasion dining and provide the community with an additional dining-out option on these holidays when many other restaurants closed down for the day.

However, there were challenges to implementation. The foremost of these were the impact on employee morale and turnover intention due to the additional working days, especially on holidays. Up until this point in the property’s history, holidays such as Mother’s Day had been important days for the restaurant, but public bank holidays had been days off for employees.

Therefore, attendance on these days would have to be made mandatory for all staff.

Getting the staff to comply with the changes and get on board with the company’s goal, while keeping morale high and controlling turnover, would be the most challenging aspect of the implementation plan.

If employees were unhappy but remained at the Inn, the new GM was concerned about the possible impact on the restaurant’s quality of service and issues related to internal marketing and word-of-mouth.

In other words, would lowered morale result in deterioration in the organisation service culture? Would it impact positive behaviours such as internal marketing efforts to upsell food and beverage or promote the restaurant in the community?

Your team have been asked by the CEO to present your advice to the senior leadership team on the challenges and best course of action to achieve a successful outcome for the issues above.

To ensure that the top management achieves success, you are required to produce a report. In this report you will be required to evidence the
following with reference to the case scenario above:

1: Evaluate and recommend a model of change that might be utilised in order to develop an environment that would allow the organisation to be competitive. 

2: Analyse what might be the major resistance from employees on the recommendations made above and, using appropriate change models and interventions, how might the CEO mitigate this employee resistance?

1. Explore and critically appraise strategies and methods used for the planning and management of change

2. Develop a plan to effectively manage a specified change.