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Case #1: Barbara Norris: Leading Change in the General Surgery Unit.

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Harvard Business School

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Camila Anderson Comas, Hannah Campbell, Kristen Cotter, and Joshua Rosen
Arizona State University
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Management 320: Organizational Behavior

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Professor Eric Knott

Sunday, January 21st, 2018
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 Like many organizations, Eastern Massachusetts University (EMU), is encountering
issues within their General Surgery Unit (GSU) department. EMU is already withstanding a
financial crisis and if action is not taken soon, EMU could face graver issues surrounding the
success of their hospital as GSU is a large working piece in the overall financial and technical
success of the hospital. Barbara Norris, a well-respected, and successful nurse at EMU, has just
taken over the GSU as the nurse manager. She willingly accepted the role, despite the issues at
hand, as she hopes to improve the current state of the unit. Norris is faced with a unit
experiencing an array of issues that affects the overall productivity and satisfaction of her nurses.
The biggest problems within the GSU unit are the lack of communication, cohesiveness
of the team, improper staffing and functional support. Change is necessary. Change such as,

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hiring and increasing nurses on staff. The current staff is too small to adequately take care of all

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the patients in the hospital; forcing nurses to have to make decisions that negatively impact the

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type of care patients receive. GSU is further hindered by the lack of effective communication;
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constant complaints are voiced but left unacknowledged. If left unacknowledged, there is no way
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to improve the units low morale and tend to the nurse's needs. In addition to improving
communication, there needs to be an established level of comfort, acceptance, and comradery
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within the unit. The current nurses at hand feel like they are not part of the team; they are talked
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poorly about and made to feel inadequate. Such behaviors make for an uncomfortable and hostile
working environment. If left uncorrected, there will be no platform in which nurses will be
comfortable enough to voice their complaints and suggestions; making change difficult to
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achieve.
These changes are important as they are essential for achieving forward progress. Norris
has the capability to improve the unit as long as she takes the time to implement the nurses
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concerns in an effective manner. Applying a detailed and specific action plan is the course of
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action Norris will need to take. First, immediately tackling the staffing issues before beginning to
work on the remaining issues; providing the nurses with immediate support through relief of the
stress induced from overworking, will allow Norris to tackle issues surrounding overall team
morale. Ultimately allowing her to bring the entire team together into one cohesive unit; the
necessary factor needed to elevate GSU into a well-regarded department at EMU.

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 Issues within the GSU Unit
Taking an in depth look at GSU’s problems, one can see there is a variety of intertwining
issues responsible for the dysfunction occurring within the department. The primary issues
revolve around communication; everyone feels like their complaints are not being heard or
improved upon. Younger nurses feel like they are being treated as lesser and bullied; “ I want to
feel like I belong and am a member of the team, but I often get indirect messages and feedback
from you. You make me feel like I am doing everything wrong but won’t address me directly or
in a straightforward manner” (Bell, Groysberg & Nohria 3). Whereas, older nurses feel that they
are not being compensated as much as they should be, and that they are performing unnecessary
work that hinders their ability to care properly for their patients. The personal dissatisfaction that

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the older nurses encounter directly affects the way they treat the younger staff, as they feel they

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are sacrificing the quality of their work. The disconnection from the team that the younger nurses

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encounter links directly to the resentment the older staff feels. The dysfunction in workplace
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relationships connects to the dissatisfaction within the nurses as they endure the stress from role
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overload. Such an overload is rooted from the weak financial state of the hospital.
The nurses feel overworked due to the mandatory budget cuts and inability to work
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overtime; “over-time could no longer be offered due to additional cost cutting measures” (1).
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The understaffing issue within the hospital affects the way the nurses do their job as they are
directly responsible for their immediate tasks but also pick up the slack of the temporary nurses,
“floaters”. These nurses are not familiar with the unit and the way in which GSU’s nurses
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perform their daily duties and hand protocol; further amplifying the dissatisfaction induced by
coworkers (1). All these factors included, the nurses at GSU are enduring the downsides of
dysfunctional working dynamics. Amplifying the issues further, morale is noticeably low as the
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nurses complain constantly, yet nothing is getting better; “GSU had the lowest employee
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satisfaction scores and highest employee turnover rate among all of the departments at EMU (1).
Considering the issues at hand, GSU is in great need of repair and the support of a strong leader.

Barbara Norris as GSU’s Nurse Manager

Barbara Norris willingly walked into a difficult situation; even more difficult than she
most likely perceived. With the challenges at hand and the negative history within her
organization she is attempting to make forward strides to improve GSU’s current situation. Her

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 success is hard to measure as she has yet to apply the changes she sees fit, in order, to improve
the situation. What can be measured, is Norris motivation and dedication to her role - despite the
uncontrollable circumstances. She does what is necessary to support her unit in these difficult
circumstances; “sat down at her (Norris) desk to catch her breath. She had been on the unit since
6:30 AM but planned to stay for another two hours to help with the transition from the second to
their shift and the orientation of the two registered nurses (RN) from the float pool” (1) Norris is
having to manage a team with a shorthanded staff, budget cuts, and overtime unavailable;
leading without grief and doing what is necessary in the moment.
Being that the obstacles she is encountering are out of her control, Norris, is making the
best of the situation. Norris is aware of the negative emotions and burden that GSU’s current

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situation is putting on her nurses. As, Norris went out of her way to give her entire unit the

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platform to speak their concerns; by organizing an off-site meeting. There is no question that the
nurses within Norris’s unit are unsatisfied with the current state of their jobs; many voiced

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concerns about their overall job dissatisfaction. The nurse’s, as a whole, mentioned their
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dissatisfaction with the lack of collaboration, teamwork, group conflict, inadequate staffing
support and disrespect from doctors and hospital personnel (3-4). By allowing her unit to voice
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their frustrations, Norris is taking the first step to realizing the full effect of the issues at hand;
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such behavior is the first step to being an effective change leader. Norris took a risk accepting
her new position; being the difficulties present, she is making decisions to make positive changes
in the long run. Norris actively listened to her nurses, allowing everyone, who felt the urge, to
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speak. Norris positive intent can be seen as she has dedicated time to sit down and reflect on the
nurse’s input; creating a list of the most common demotivating and frustrating aspect of the
nurses day to day jobs. Norris is realistic with the matter at hand as she understands she must set
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“realistic, attainable goals for each item on the list” (4). Overall, Norris is doing what she can in
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the situation and is taking the necessary steps to address the issues by setting clear goals and
leading with a supportive attitude.

Challenges Norris is Encountering

Taking a closer look at the trials Norris is facing as the manager at GSU, reveals many
gaps in communication. This lack of communication has led to further problems between

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 coworkers and created a series of complaints to management. In the past, these complaints have
been left unaddressed. These complaints directly tie to the challenges GSU is currently facing.
First, there is a downgrading judgment among workers; senior nurses have a tendency to
be much more critical of newer nurse’s work as they feel the newer nurses are inexperienced.
Yet, the older nurses, rather than being willing to help out, they gossip about the newer nurses.
Creating a hostile work environment that takes the focus away from the patients and their
treatment. Furthermore, there is dissatisfaction with the treatment on the patients part and a
discouragement of work on the nurses end. Such strife leads to the second issue - lack of a
cohesive unit. Megan, one of the GSU nurses expressed her concerns at the off-site meeting, “I
want to feel like I belong and am a member of the team, but I often get indirect negative

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messages and feedback from you. You make me feel like I am doing everything wrong but won’t

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address me directly or in a straightforward manner” (3). Megan is concerned that she cannot

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progress as she feels that she needs to ask questions for her self-improvement, yet she only
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receives negative feedback. She is divided from her coworkers, when in fact she should be a able
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to rely on them as a loyal support system in growth and learning. Furthering complexities arises
through the inadequate and ill-maintained performance review process within the GSU unit.
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Thirdly, the lack of review process from unit leads has stunted the growth of the nurses.
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Another nurse, Jennifer, mentions her frustration at the meeting by further stating that she is
frustrated that there is not a proper way for her to receive feedback (3). Feedback is vital in the
process of personal improvement; in order to foster growth and teamwork. Along these same
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lines there is no guidelines or reward for advancement. Jennifer brings that to light as she
described her frustrating around the fact that there is no acknowledgment when it comes to
staying up to date on new technologies (4). This creates a lack of motivation to improve as
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staying up to date with new technologies requires sacrificing extra time and money outside of
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work. Ultimately, the lack of eagerness to stay up to date inhibits the unit as there is a general
lack of experience and skills among the nurses.
One of the last challenges Norris is facing is the improper use of time and shortage of
necessary labor. At the meeting, another GSU nurse, Louise, mentions how she is stuck working
on the machines rather than patient treatment; claiming, “everyday I have to make difficult
decisions about what I cannot do for patients. I resent this because we have too few nurses in the
ward and because some of that staff is inexperienced to boot, I am put in the position of having

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 to pick and choose the care I can give” (4). Louise’s lack of time to complete her own tasks
further contributes to the frustration and negativity geared towards the more inexperienced
nurses. Such negativity damages the environment not only for the nurses, but gets in the way of
the number on reason they are all there; to care for patients.
Norris is amidst a difficult situation with an overarching problem at fault; lack of
communication. This problem came directly from the nursing floor, between coworkers, and all
the way to the director of nurses. This is creating frustration between the individual nurses and is
putting stress on the entire unit. The unit is not cohesive enough to handle the pressures these
problems are causing. Norris came to this realization and has made a plan to actively listen to the
nurse's frustrations. Further communicating that she (Norris) is there to support and stand beside

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her staff.

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Solutions and Next Steps
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It is important for Norris to address the challenges by focusing on the most efficient and
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effective way to change the overall environment at GSU. Labor is not managed well, employees
do not feel recognized, and training is not regulated. Each of these problems can be easily fixed
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if the entire staff communicated transparently. The goal for Norris, and for all of GSU, is to
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create a strong, cohesive workplace for the staff.

In order for this to be accomplished, Norris should implement an action plan at GSU with
and overall focus on the staff. She should first hire an additional nurse within the next month to
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in order to rely less on RNs, or floaters, as “‘floaters’ were not familiar with the unit, its specific
procedures and care protocols, they more often than not had additional negative effects on staff
dynamics and the quality of patient care” (1). Floaters require the regular staff on duty to pick up
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the slack when they are not up-to-date. While looking for another nurse, and after one is hired,
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Norris should implement bi-weekly meetings with each staff member to provide feedback and
acknowledge individual progress on-the job. These meetings can be brief check-ins; informative
periods to check in on the employees giving Norris the opportunity to gather more information
on the needs of the entire unit. After running these meetings for three months, Norris should hold
another offsite where she can present her goals for improvement. Additionally, Norris should
take this time in order to teach basic machine use for all of the newer members at GSU. Taking
time to ensure that everyone knows how the equipment functions. Each of these steps will help

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 counter the negative aspects of GSU, leaving only the poor culture in the unit to be fixed. In
order to build a cohesive unit from the staff members at GSU, the existing employees will need
to find common ground to start forming healthy relationships. To do so, Norris should implement
a mentoring program in which senior nurses guide new nurses through their first two months on
the job. This mentoring program will build relationships between the senior staff and the new
staff as well as allowing the younger staff members to help senior nurses learn about new
technology in the unit.
Approximately six months after initially introducing these changes to GSU, Norris can
measure improvements by looking at staff involvement. There should be less gossip throughout
the unit as relationships have been formed through not only mentoring, but also as a result of the

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offsite training of machinery allowing nurses to tend patients more frequently. The bi-weekly

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meetings can remain for Norris to continue bettering employee attitudes, receive and provide

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feedback, and improve the unit overall. Ultimately, the entire department should see an increase
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in retention rates and a decrease in employee turnover.
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 References

Groysberg, Boris, et al. “Barbara Norris: Leading Change in the General Surgery Unit.” Harvard
Business School , 13 Mar. 2009, pp. 1–5. Harvard Business School.

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