HCM 3070 Module 6 Final Project Part 2 Example

Closing the Gap Between the Plan and the Floor at Cedar Ridge: Analysis and Recommendations for Managerial Roles, Training and Personnel

Student Name

B.S. in Healthcare Management, Thomas Edison State University

HCM-3070: Principles of Healthcare Management

Mentor Name

Month Day, Year

Closing the Gap Between the Plan and the Floor at Cedar Ridge: Analysis and Recommendations for Managerial Roles, Training and Personnel

Part 1 portrayed Cedar Ridge, the course's invented community hospital, and reported an executive team that sets targets well, a chief operating officer whom staff see as the leader who listens, middle managers who lead in very different ways, untrained charge nurses, good information flow on days but little at night, and a plan that staff did not recognize in their daily work. Part 2 analyzes these findings through the roles managers play, considers alternative explanations for the differences between units, and recommends changes in training, budgeting and personnel that would help leaders guide practitioners and plan their budgets, training and personnel more effectively.

Analyzing the Findings Through Managerial Roles

Managers at every level perform interpersonal, informational and decisional roles: they lead and connect people, gather and pass on information, and allocate resources and solve problems. At Cedar Ridge, the decisional role is strong at the top. The executive team sets clear targets and monitors them. The informational role is where the system breaks down. Information flows upward well through the daily safety huddle and dashboards, but downward mainly through email and town halls that frontline staff, especially at night, do not receive. The interpersonal role depends almost entirely on individual managers, which explains why 5 East and 5 West feel like different hospitals.

The contrast between the two units deserves a careful reading. The 5 West manager oversees two units and about 95 staff, roughly twice the span of the 5 East manager, and was promoted without leadership training. Cathcart et al. (2004) reported that a health system that studied managers' spans of control found a strong relationship between large spans and lower employee engagement, and that adding four management positions was followed a year later by improved engagement in all four affected areas. Lee and Cummings (2008) found in a systematic review of fourteen studies that span of control, organizational support and empowerment were among the factors related to frontline nurse managers' job satisfaction. Other explanations are possible: 5 West has more new graduates and a longer commute for many staff. But the span and the lack of support for its manager are the factors the hospital can change.

Training Recommendations

The first recommendation is a charge nurse leadership program. Charge nurses lead every shift, including nights, yet receive no preparation for the role. Krugman et al. (2013) evaluated a charge nurse leadership program over sixteen years at one academic hospital and found that charge nurses' ratings on a standard leadership practices inventory improved, and that relief charge nurses reached similar scores over time. Cedar Ridge's program would give each of about forty permanent and relief charge nurses sixteen paid hours of training over four months, covering coaching, delegation, conflict, escalation and communicating the hospital's priorities, with sessions offered on both day and night schedules.

The second training recommendation is a leadership development plan for new managers, starting with the 5 West manager: a mentor from among experienced managers, monthly coaching and a defined set of skills to build in the first year, including budgeting, scheduling and running effective unit meetings.

Personnel Recommendations

The third recommendation is to narrow the span of control on 5 West by adding an assistant nurse manager, so that one leader is consistently present on each unit and evening coverage improves. The fourth is to give nights a leadership presence. The house supervisor and the executive on call would round on every unit at least twice a week between 11 p.m. and 3 a.m., asking staff what is getting in their way and reporting issues at the next morning's safety huddle. This turns an existing role into an informational channel at no added cost.

Both recommendations are designed to be sustainable after the first year. The charge nurse program will train two experienced charge nurses as co-facilitators so it can continue without outside help, and the night rounds will be added to the house supervisor's written duties and to the on-call executive's checklist, so they do not depend on the enthusiasm of the people who start them.

Communication and Budget

The fifth recommendation addresses strategy. Town halls would be recorded and one held each quarter at 7 a.m. so night staff can attend before leaving, and a one-page update for frontline staff would replace the monthly email, stating each priority as a commitment with progress, for example how many nurse vacancies were filled, rather than as a target. The table sets the costs against the returns we expect. In year one the program costs roughly $170,000. Using the hospital's estimate of $48,200 per registered nurse separation from the turnover analysis in Module 4, preventing four separations a year would offset the cost; the 5 West turnover gap alone is larger than that.

Evaluation and Conclusion

The recommendations should be evaluated at six and twelve months with measures already collected or easily added: registered nurse turnover by unit, employee engagement scores by unit and shift, the share of staff who can name the hospital's three priorities, charge nurse leadership inventory scores before and after training, and attendance at town halls by shift. If 5 West's turnover does not fall toward 5 East's within a year, the hospital should revisit the other explanations identified in this analysis.

Cedar Ridge does not lack leadership; it lacks leadership that reaches every shift. Strengthening the informational and interpersonal roles of managers through training, a narrower span of control and deliberate communication would help the hospital's plan become something staff can see on the floor.

References

Cathcart, D., Jeska, S., Karnas, J., Miller, S. E., Pechacek, J., & Rheault, L. (2004). Span of control matters. JONA: The Journal of Nursing Administration, 34(9), 395-399. https://doi.org/10.1097/00005110-200409000-00004

Krugman, M., Heggem, L., Kinney, L. J., & Frueh, M. (2013). Longitudinal charge nurse leadership development and evaluation. JONA: The Journal of Nursing Administration, 43(9), 438-446. https://doi.org/10.1097/NNA.0b013e3182a23b26

Lee, H., & Cummings, G. G. (2008). Factors influencing job satisfaction of front line nurse managers: A systematic review. Journal of Nursing Management, 16(7), 768-783. https://doi.org/10.1111/j.1365-2834.2008.00879.x