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The current essay provides a short description of United Health Services Inc. and its activities. The emphasis is made on the investigation of problems of the company and setting of the diagnosis to its performance. This understanding enables development of a plan of transformation of the organizational performance by utilizing Kotter’s 8-Step Approach. This work shows how application of the methodology presented by Kotter will help to manage issues connected with the quality of health care services provided by United Health Services Inc.
United Health Services Inc. is a public traded company established in 1978 and at the current moment headquartered in King of Prussia (Pennsylvania). The company is the owner and operator of various health care institutions like behavioral health centers, ambulatory surgery centers and surgical hospitals, acute care hospitals, and radiation oncology centers. These institutions offer numerous services, for example, internal medicine, specialty and general surgery, behavioral health services, pediatric services, and pharmacy services. In the current year, United Health Services Inc. owns and operates 216 behavioral health centers and 24 hospitals through its subsidiaries. Its health care institutions are located in the USA, the UK, and Puerto Rico. As per information provided on the official web-site, United Health Services Inc. was in Fortune 500 list in 2014. The company has the annual revenue of about USD 8 billion and net income of more than USD 580 million.
The success of the company is based on its intentions to build or acquire hospitals, which render high quality medical services in growing markets, and to invest into the equipment and employees, which are necessary to make these institutions dominate in their communities. United Health Services Inc. continuously analyses and improves the quality of health care provision by enhancing existing programs, technologies, and services. Besides, additional attention is paid to constant training of employees and aggressive recruitment of nurses, physicians, and allied health staff. Moreover, United Health Services Inc. performs selective acquisitions that make strategic sense. This becomes possible because the company has ready access to capital and well-managed debt. It should be noted that the management of United Health Services Inc. emphasizes diversification of the business by owning and operating both behavioral health facilities and acute care hospitals. At the same time, it has the aim to make the company the market leader in each of these niches.
At the current moment, United Health Services Inc. has considerable problems with the quality of rendered services. It is notable that these problems became apparent several years ago.In 2009, United Health Services Inc. agreed to pay to the federal government USD 27.5 million for resolving allegations in three of its hospitals located in South Texas. These allegations concerned payment of kickbacks to physicians in the form of leases and sham medical directorships. In the same year, two units of Arbour hospitals were noted as having low levels of safe standards, 2 questionable deaths, and numerous staff failures. In the article “Psychiatric hospital chain reports further govt. troubles –universal health services’ Timberlawn hospital could close because of jeopardy to patients”, it is noted that two years later health officials in Pennsylvania stopped one of the company’s mental centers from rendering services to the youth and children. This decision was based on the outcomes of special investigations, which showed that patients were treated in poor conditions by an insufficient amount of carers. Besides, there was an excessive use of physical restraints. In 2011, several other issues were found out in subsidiaries of the company located in North Carolina. They concern the incompetentence of the clinical staff and understaffing.
One more allegation was settled in 2012. The company and its two subsidiaries (Keystone Marion LLC and Keystone Marion LLC) agreed to pay to the American government USD 6.85 million for the settlement of allegations concerning the fact that these health care institutions “provided substandard psychiatric counseling and treatment to adolescents in violation of Medicaid requirements, falsified records and submitted false claims to the Medicaid program”. Jason Cherkis in the article concerning this case noted the following issues of treatment performed in the company’s subsidiaries: lack of education programs, unclothed inmates, provision of psychological therapy in hallways of institutions, sexual abuse of residents, and brutal responses to resident compliance. In 2013, the Illionoise Department of Children and Family Services stopped sending patients to one of the universal hospitals managed by United Health Services Inc. because it had found out such issues as inadequate employee trainings and documented violence.
In 2014, new allegations about the treatment in United Health Services Inc. (particularly in a Brookline psychiatric hospital Arbour HRI) were described in the article “Union, hospital clash on worker who spoke to Globe”. The author noted that the health care institution failed to treat 4 patients during the inspections. These people with diagnoses of paranoid schizophrenia and bipolar disorder were obliged to wait in hallways for many hours for their therapy. Moreover, the author stated that the administration forbade its employees to speak with representatives of the mass media concerning the hospital as, otherwise, they could lose their jobs.
In 2015, one of the company’s institutions (Timberlawn Mental Health System) obtained notification from the Center of Medicare and Medicaid concerning its intention to terminate the provider agreement because the hospital had numerous deficiencies. Health care providers were unable to perform routine checks of suicide patients and help patients in distress. Besides, there remained some unsafe objects (like electric cords) in rooms of suicide patients. Moreover, the observers noted the overstated cost of prescriptions of psychiatrists. All these deficiencies were considered as “immediate jeopardy”.
In general, all the issues of United Health Services Inc., which became apparent to the society from 2009 till 2015, concern several matters: inefficient staff training, incompetence of employees, understaffing, lack of attention to patients’ needs, inappropriate conditions of treatment, and low levels of safe standards. At the same time, all these issues allow the company to obtain extra high profits. Lisa Schencker in her article noted the following: “UHS has achieved high profit margins by reducing staffing costs and keeping occupancy rates high”. This idea is based on the understanding that United Health Services Inc. saves considerable funds on trainings, appropriate staffing, and ensuring of appropriate health care provision conditions. These savings enable obtaining surpluses far above the level of average profits of other hospitals. For example, in 2012 Arbour’s Massachusetts hospitals (subsidiaries of United Health Services Inc.) obtained profits from 15% to 32% when other large psychiatric hospitals in the same location reported single-digit revenues.
Notwithstanding the fact that the described issues enable United Health Services Inc. to obtain high profits, they can cause considerable problems, which jeopardize further development and even existence of the company. As it has been mentioned above, the inappropriate treatment of patients leads to closure of some hospitals, stoppage of rendering health care services by various officials all over the country, and even termination of the agreements with Medicare and Medicaid. If the tendency of rendering low-quality services is preserved, the company will lose a considerable sum of money because of closure of its hospitals. Besides, it will be forced to develop and implement extra measures for the immediate solving of this issue. Moreover, United Health Services Inc. will lose people’s trust and will become less popular. Hence, its position in the health care industry will become weaker. All of these possible consequences and the fact that the company has had numerous issues connected with the inappropriate treatment of patients during the last 5 years prove urgency of changing the organizational performance for avoiding the stated problems.
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Kotter's 8-Step Approach
The current essay will propose the solution of the above mentioned issues by using Kotter’s 8-Step Approach. This approach is used because it enables quick and effective business transformation in the chosen direction. As described in the article “Challenges facing change management theories and research”, it is applied “at the strategic level of an organization to change its vision and subsequently transform the organization”. This short description of each step is given in Table 1.
Kotter's 8-Step Approach and description of each step.
It is notable that the first four steps are focused on bringing to employees the understanding of the necessity to implement changes into the organizational performance. The next steps are directed at the realization of stated changes into real life. As it is mentioned in the article “Assessing the implementation of a non-profit organizational change initiative using Kotter’s 8-Step Change Model”, this approach enables “unfreezing, moving, and refreezing model of change”. At the same time, authors of the work “Comparative study: The Kurt Lewin of change management” state that this methodology is more directed at changing human behavior than the strategy, system, or culture.
The current essay will provide description of the plan directed at the transformation of United Health Services Inc. by using Kotter’s 8-Step Approach for resolving the above stated issues. In general, the plan will be implemented for the improvement of the staff training with a view to increasing the competence of health care providers and ensuring that hospitals have sufficient amount of staff and support appropriate conditions of treatment of patients.
The first step of the plan will be establishment of the sense of urgency. All employees (from top managers to nurses) in all subsidiaries should clearly understand the necessity for the development of initiatives of staff training and insurance of appropriate conditions of treatment. The next step of the plan will be represented by creation of the special team of representatives of various departments of health care institutions that would develop and realize training initiatives, assess sufficiency of the amount of workers in hospitals, and check conditions of treatment of patients. This team should be empowered to influence administrations of hospitals, which provide low quality of treatment. The third step of Kotter’s 8-Step Approach for United Health Services Inc. will be represented by the creation of the vision and development of the strategy. The new vision and strategy of the company should be directed at the improvement of the quality of rendering health care services and of the appearance of the company. The proposed vision is the following: giving patients the best possible care provided by professionals in superior conditions. As per personal understanding, the new strategy should be the following: ensurance of rendetion of high quality services by investing in people and equipment and thorough control over all stages of treatment for becoming the best health care company. The next step will be represented by communication between the guiding team and the rest of employees through special seminars where employees would be provided with statistical data that show how their negligence and unprofessionalism worsen health of patients and image of the company. Additional attention should be paid to the stipulation of hospitals to hire an appropriate amount of the staff. It can be performed by negotiation with the administrations for the explanation that understaffing worsens appearance of the hospital because it decreases the quality of rendered health care services.
The guiding team should pay much attention to the empowerment of common employees to remove any obstacles like their unwillingness to obtain additional trainings for mastering their skills and to support appropriate conditions of treatment. This empowerment represents the fifth step of Kotter’s 8-Step Approach. It can be reflected in the provision of additional financial bonuses to employees who have completed trainings, successfully passed final tests, and improved the quality of their work. The issue of understaffing can be met by providing financial support from the side of United Health Services Inc. to hospitals that hire a sufficient amount of highly qualified employees. The guiding team should establish some kind of short-term goals for employees and administrations of hospitals. Fulfillment of these goals will provide the above mentioned benefits. As it has been already stated, short-term wins for employees may be reflected in completion of trainings and successful passing of tests, while short-term wins for the administrations can be represented by the increase of the staff. Besides, the guiding team should control frequency and completeness of fulfillment of these short-term goals. Such control will represent the seventh step of the plan. The last step will be incorporation of changes into the organizational culture by means of constant assessment of employee’s professionalism and the quality of patients’ treatment. Much attention should be paid to the reinforcement of changes by “highlighting connections between new behaviors and processes and organizational success”.
It should be noted that this work provides understanding of the application of Kotter’s 8-Step Approach for solving the issues faced by United Health Services Inc. These issues are the following: inefficient staff training, incompetence of employees, understaffing, lack of attention to patients’ needs, inappropriate conditions of treatment, and low levels of safe standards. Study of numerous articles shows that the company has had these problems for more than 5 years. They can threaten further development and even existence of United Health Services Inc. because they can lead to closure of hospitals and loss of people’s trust. Consequently, the urgency of solving the above mentioned problems is apparent. Kotter’s 8-Step Approach is one of the most effective methodologies of a quick and effective implementation of changes into employees’ behavior, strategy, system, and culture. The developed eight-step plan is directed at the improvement of the staff training for increasing competence of health care providers and ensuring that hospitals have a sufficient amount of the staff and support appropriate conditions of treatment of patients for management of the defined problems.
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