Operational Analysis And Quality Improvement

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Robert Geinosky

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Lawrence G. Fine once said, in reference to the effective use of a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis, “Use your strengths to overcome your weaknesses, and use your opportunities to overcome your threats.” Four years ago, when I was asked to manage the EVS team, the department was extremely dysfunctional and inefficient. Although team labor was in-house, management services were out-sourced, and not respected or trusted. Realizing this, each team member was asked to provide feedback regarding current working conditions. We immediately performed a SWOT analysis based upon these results.

What we found was staggering. We discovered that one of our greatest strengths was that most of our 300 EVS department employees were dedicated, professional, and always willing to make the necessary efforts to provide safe and healthy environments for all patients, staff and visitors. Conversely, there were some staff members who would intentionally sabotage operations, with the intent of eliminating any permanent, positive changes to the organization that would disrupt their accustomed avoidance of their assigned responsibilities. But further evaluation also resulted in the identification of the team members who were willing to wear many hats, in the performance of their responsibilities, from working extra hours, to volunteering for additional training in Infection Prevention, in order to help eliminate hospital-acquired infections. (Chung, 2021)

Evaluation of employee feedback revealed that our weaknesses included supervisors who were not treating all team members equally, especially when assigning schedules. This was also true in the way corrective actions were issued. Less popular associates were often given harsher penalties than those favored team members who committed similar offenses. We also uncovered the lack of a preventive maintenance program for our floor care equipment, as well as intentional sabotage of this equipment, to create excuses for non-performance. The lack of equal treatment of team members was generating legitimate management distrust.

One of the first opportunities eliminated the out-sourced management services. Removing the management team responsible for the discontent was the first step toward improving team morale. Improving working conditions within our organization reinforced the message that we were intent on fixing what we felt were broken processes. We next looked at  the allocation of labor. Wasted resources, as well as inefficient schedules, were addressed. Needless to say, the staffing model we developed, as a result of these findings, brought a certain amount of backlash. At first, team members thought that we were just going to add more work to their already extensive assignments. They believed there would be a reduction in quality, where the work would either be done poorly, or not done at all, ultimately culminating in low employee morale and/or an increase in the department’s turnover rate. (Stathakis, 2015)  Only with effective communication from leadership, at all levels, were we able to gain the respect and trust needed to guide our team members through this difficult transition.

Threats we faced came from employees who opposed the changes made, were intent to continue the disruption of our newly-implemented changes, and insisted that we would fail in fairly carrying out the new processes over the long run. Equipment was also continually abused, resulting in excessive breakdowns. In response, new procedures were enacted, to ensure that all those who used the equipment would be held accountable, for its proper use and maintenance. As we uncovered those who were trying to destroy the newly-formed department culture, certain team members began to call in prior to their shifts, to inform management that they were sick, and would not be reporting to work that day. These unwarranted absences resulted in creating a minimum of a 10% call-off rate, in addition to the legitimate call-offs, which run approximately 5%. To counter this, we began to offer incentives of bonus pay for perfect attendance, extra compensation for working overtime, and additional paid time off.

Senior leadership realized the need to improve quality within our facility. After careful evaluation of the state of affairs at the time, one of the techniques used to determine the most effective course of action was to perform a SWOT analysis. It was determined, after identifying needs, that adjustments had to be be made. Once the most-needed improvements were identified,  plans were implemented to address these shortcomings. They then had to be monitored and maintained. (Chung, 2021) However, long-term success requires continually making adjustments to the plans, to accommodate changing priorities, within the evolving landscape of the healthcare industry.

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