Organizational Problems at Whittier

The professional staff at WSHC believes that some of the individual managers at WSHC are well-meaning, hard-working people who are often trying to do their best. However, they work within a system that undervalues the role of non-managerial staff, and for that reason the system is unable to create strong teams that can effectively solve problems. The lack of accountability of managers to non-managerial staff has created layers of dysfunction within the health center which impact the care we provide to patients.

There are three main problem areas at Whittier that affect our ability to provide quality care:

Productivity

Productivity expectations are one of the metrics that most influence our ability to provide good care to patients at Whittier and which most affect the job satisfaction of providers. High productivity is vital to the financial success of the health center. However, it needs to be achieved in concert with the delivery of high quality care.  This can be accomplished through such things as the creative restructuring of teams and addressing some of the root causes of inefficiencies that keep providers from being able to see patients faster. But instead of having open discussions about the best ways to achieve higher productivity, while also providing high quality care, productivity expectations have usually been imposed on providers, often abruptly, without adequate discussion of the ramifications for patients and providers. For example, in one department, Behavioral Health, productivity expectations were increased in one year alone (2017) by almost 40%, without providing supports to providers to allow them to continue taking the best care of their patients.

High staff turnover

Job dissatisfaction around such issues as productivity has played a major role in the high turnover rate of staff at Whittier. For example, over the past two years, in the non-specialty departments of Adult and Family Medicine, Pediatrics, and Urgent Care, there has been a turnover of 150% of RNs (20 hired and trained to fill 8 positions) and a turnover of about 90% of providers (44 hired and trained to fill 23 positions). The resulting loss of accumulated institutional knowledge and experience, and the disruption in continuity of care to patients, has had an enormous impact on care. Turnover has also been financially costly to Whittier.

Managerial issues

1. Staff proposals to fix important problems are often ignored or dismissed without further discussion

Examples:

2. Minimal opportunity for discussion of policies and problems between management and staff

Examples:

3. Lack of proper consideration of legal and ethical consequences of policies which impact providers and patients

Examples:

4. Problems with follow-up and attention to detail

Examples:

5. Lack of managerial accountability

6. Atmosphere of intimidation

May 2018