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"We value employee participation; everybody has something to contribute."


"We're all part of the same team; together we can make a difference."


"And by the way, occupancy is dropping and this community has many more beds than are needed and competition is eroding our market share, so we are finding it necessary to undertake a major reengineering effort which, unfortunately, could result in some layoffs."


Is the foregoing a strange combination of inconsistent statements? Inconsistent, yes, but in recent years, far from strange.


Although the total quality management peak seems to have passed, there is still plenty of similar activity occurring under other names and a great deal of information available about how to achieve more with fewer resources while maintaining or improving quality. At the same time, "reengineering" remains one of the more popular concepts in organizational management today. In light of continuing quality improvement efforts and economically driven reengineering or reorganizing efforts, many employees are receiving a mixed message: You are all important and your contributions are needed, but we no longer need as many of you.


Some may argue perceived or imagined differences in terms, but in a practical sense, reengineering is often the label attached to downsizing, right-sizing, or any of a number of other terms that all mean "Let's reorganize the way we do business and eliminate some jobs." This is surely a gross oversimplification, but consider whether you can think of a reengineering effort that did not result in the elimination of some positions.


A successful total quality implementation gets people fired up, gets some of them truly involved, and encourages them to believe that they are an important part of the organization, then along comes the reengineering effort that removes a number of people from the organization. Those employees who remain are then expected to continue to perform with their total-quality-induced enthusiasm. Of course they do not. Rather, the survivors-for that is how many will think of themselves-will begin to wonder when the next reduction will occur. And employees who are insecure about their future are not nearly as effective as they could be.


We are told that in many undertakings, timing is everything. Timing is certainly everything in the relationship between a total quality management implementation and a reengineering effort. Health care organizations and manufacturing and commercial firms alike have committed the same errors of timing, seeing the best of their quality improvement efforts washed away by a wave of layoffs.


There is, of course, a time to downsize (or right-size, reorganize, or whatever), as there is also a time to emphasize quality and customer service and work for their improvement. However, if the group you happen to manage has experienced the mixed message presented when reengineering too closely follows a quality improvement effort, your task has become more difficult. It is basic in employee motivation that uncertainty and insecurity have a negative effect on performance, so you will need to work extra hard to maintain your staff's enthusiasm, as well as your own.


This issue of The Health Care Manager (32:3, July-September 2013) offers the following articles for the reader's consideration.


* "Transitioning to a New Nursing Home: 1 Organization's Experience" describes the formulation and implementation of a plan intended to assess the impact of a significant move to a new facility on affected staff, residents, and families and reports on the lessons learned from this large-scale transition.


* "A Framework for Improving Access and Customer Service Times in Health Care: Application and Analysis at the University of California, Los Angeles, Medical Center" reports on a study that resulted in a framework for improving access and customer service in health care settings through synthesis of the operational concept of the bottleneck with queuing theory.


* "The Affordable Care Act: The Ethical Call for Value-Based Leadership to Transform Quality" addresses the need for value-based leadership in adapting and reshaping the health care provider organization to continue the delivery of quality health care given the challenges presented by the Affordable Care Act.


* "Succession Planning: Trends Regarding the Perspectives of Chief Executive Officers in US Hospitals" reports on a study undertaken to revisit the perceptions of chief executive officers in US hospitals concerning the origins of leadership and their feelings about internally developed successors versus externally recruited successors.


* Case in Health Care Management: "Did He Have It Coming?" asks the reader to consider the validity or lack thereof of an executive manager's response to an apparent error by a subordinate and suggests how the situation might have been more appropriately handled.


* "Information Therapy: A Prescription for the Digital Era" reintroduces the concept of information therapy, highlights its relationship to patient-centric care, and suggests steps for developing an information therapy program within a health care organization.


* "Electronic Health Systems: Challenges Faced by Hospital-Based Providers" addresses the specific challenges faced by hospitals in adopting the use of electronic medical records and implementing electronic health record systems and suggests how these challenges maybe met.


* "Bibliometric Investigation on Preventive Medicine in North Korea: A Coauthor and Keyword Network Analysis" reports on a study undertaken to examine the direction and emphasis of a pair of North Korean preventive medicine journals as contrasted to the differing approach to preventive medicine in South Korea.


* "Adoption of the ICD-10, Standard in the United States: The Time Is Now" addresses the upcoming replacement of the present disease-coding system with the new ICD-10, system, which is already in use in a significant portion of the international health care community.


* "Improvement of Hospital Performance Through Innovation: Toward the Value of Hospital Care" reports on a critical analysis of the relationship between innovation and performance in the hospital sector in Portugal, identifying organizational flexibility and external cooperation as major factors in explaining the differences found among hospitals.


* "Improving Organizational Climate for Excellence in Patient Care" suggests that developing and maintaining a positive organizational climate can help improve employee motivation and foster improved employee performance and offers means of assessing organizational climate, analyzing barriers to a positive climate, and building a climate that fosters high performance.


* "Counteracting the High Cost of Low Morale in the Health Care Sector" describes the unique challenges faced by leadership and employees in health care in aligning employees with the goals of the organization and improving professionalism, effectiveness, and accountability in all areas of the organization.