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Austin Holmes

NYMC HPM 6048


Dr. Thomas Saccardi

Retina Eye Specialists: A futuristic view


BACKGROUND:
Retina Eye Specialists was started approximately 5 years ago in the Los Angeles Area. Over
those years, it has enjoyed growth and has become a highly specialized group. However, demand
for purely retina services has diminished, and now the time has come to look into other
opportunities for growth. Retina Eye Specialists plans on staying in the eye care business and
plans on having, as its corner stone service, retina care. Particular care must be taken so as not to
ruin relations with current referral sources. In-fact, relations with these sources should be
strengthened through cooperative arrangements. The following plan is a futuristic view of how
Retina Eye Specialists will one day look.

MISSION STATEMENT:
It is the mission of Retina Eye Specialists to provide cutting edge treatments for retinal and
vitreous diseases. In accomplishing this objective our ethics as responsible members of society
will not be compromised. It is our guarantee that each patient will be treated, at all times, with
the proper dignity and respect that one human is to give to another human. The patient’s
financial situation will be respected and we will do everything to minimize out of pocket
expenses to the patient.
Physicians at Retina Eye Specialists are wholly dedicated to the care of their patients, and in
giving personalized care will spend whatever time is necessary to fully explain every aspect your
condition and what treatment options are available.

ORGANIZATION:
As stated above, the below chart is how Retina Eye Specialists will look in the future.
Retina Eye Specialists will utilize an organic model, which is in line with our goal of providing
excellent retinal care. However, each department must be differentiated into its parts, and then
integrated at the higher levels. The main differentiated departments would be finance, operations
and marketing. The chart below is a little deceptive however. None of the offices would be
considered the “main office.” The main headquarters would be located at one of the practice
locations, thus allowing all locations of the business to be involved in income creation. In other
words, no dead space. Also, each location would have its own separate staff from each of these
differentiated departments. For instance, each office would have its own marketer, its own billing
staff and its own techs. However, since standard is standardized, any of these employees can
“rotate” between offices. Another key to success of this model is a centralized database system.
Thus, a VPN between offices with a centralized server would be utilized. This will be discussed
more under communication. Below is a discussion of each differentiated department:
Finance: The finance department is responsible for everything from investments to real estate to
medical billing. The CFO is in charge of all these aspects. The CFO and his “local” staff will
handle accounting, investments and financial strategy. The satellite billing staff will be located in
each office, dealing only with their set of patients. This will allow the patients to get to know,
and feel comfortable with the billing staff, thus building a more trustworthy relation. Also
included in each office would a claims denial specialist (since these take up much time, and
require a higher skill level than regular billing) and an HMO specialist (if demand for that office
warrants one. If not, HMO cases would be referred to an HMO specialist at another location).
Operations: This department is responsible for the day to day operations of each individual
practice. Their duties would include; inventory, checking in-checking out patients, scheduling
patients, assisting the marketing staff in procuring necessary materials, assist the billing staff in
medical records, release medical records to requesting agencies/patients, assisting physicians,
management of local network, and any other operations issues that may arise through-out the
course of the day. Another title for these people would be administrators. The Community events
coordinator is an exception; he/she is responsible for all community service events that the
organization engages in, and coordinates with other offices or vendors to expand this “service.”
He also works very closely with the marketer.
Marketing: The Chief Marketing Office (CMarkO) and his staff is responsible for all aspects of
marketing. This includes marketing of each individual office to the local community and creating
initiatives that target the local patient population. The CMarkO is responsible for the
coordination of these efforts so that a unified and standardized image of the business is extended.
The Integration: The integration subsystem comes from several different areas. The main source
is the coordination/strategic level, which includes the CEO,CFO, CMarkO, COO and CMO. It is
at this level that strategies are formed that coordinate the efforts of each department. The VP is
more of a staff member who acts as an advisor. His power derives indirectly from the CEO in
making sure that projects are on track and being coordinated with other departments. He could be
called the Chief Coordination Officer and reports directly to the CEO. Other levels of integration
take place within both marketing/operations and finance/operations and marketing/finance.
Medical
Committ Coordination/Strategic (upper
ee management)
Top level executives
Medical
Staff VP
CMO CE
O Ambulatory Unaffiliated
HMO CF Surgery Anesthesiolog
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billing Manager ist
O O
Physicians/ staff
PA Other CMarkO Office manager Surgical
method for each Staff
s location
Communit
Denials
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spec. Individual
Events
marketers Tech. staff
Coordinat
Denials or
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External
organizatio
ns
THE CULTURE:
The culture is directly based on the ideas delineated in the mission statement. These principles
are the core values that Retina Eye Specialists holds as the foundation of our business and must
be instilled in each new employee and reinforced in every current employee.
The Core Values:
1. Each patient is to be treated with respect and dignity.
2. To provide exceptional care, even at personal expense.
3. To act as an advocate for the patient to reduce the total out of pocket costs for treatment.
4. Continuously learn and express ideas that further ones’ self and the organization.
Commitment to these values is essential for the success of the organization and to each
individual within the organization. The idea is to create an Entrepreneurial culture, whereby each
employee feels valued by the organization, and each employee values the customer. To establish
the culture, each new employee receives on top of their specific position training, training in the
values and attitudes of the organization.
The Cultural Plan:
1. An introduction of the history of the organization and how it has progressed in the past.
2. Meetings attended by upper management to instill how important this subject matter is.
3. Clearly state the core values and why they are important.
4. Have group discussions regarding the core values.
5. Have a workbook whereby the employee can write how he/she perceives the core values
and have them relate it to their own life. Have them explain why the core values are
necessary.
6. During the training period, have a mentor that the new employee can go to. Have the
mentor actively involved in the new employees training so that real life examples of
practical application of core values can be discussed in a two way manner.
Each current employee will be evaluated on how well they embody the core values of the
organization during their performance reviews. Deficiency in this area will necessitate the need
for mentoring. During this mentoring process, the employee will be required to write in a
“journal” why the core values are important, how they can be used in a day to day basis and what
the core values mean personally to them.

GROUPS/TEAMS:
Both formal and informal groups are an important part of any organization, and this is especially
true of retina eye specialists. Having cross-functional groups not only allows for better, more
effective decisions, but also for better coordination amongst departments. In-fact, the formation
of formal and informal cross-functional groups/teams should be encouraged.
The cross functional dynamics:
• Formal cross functional teams:
o Group specific for community service event. At the event itself, the community
service events coordinator, a marketer and an operations person is present.
o A group on billing procedures to include operations and finance members.
o A group on operations to include members from operations and finance.
o A group on service enhancement/expansion to include members from finance,
marketing and operations.
• Informal cross functional group:
o Members from different departments should be encouraged to create friendships.
This could possibly be done through mixers.
o Team sports, or an outing could be planned.
o Directed by organization higher ups to better focus informal groups efforts on
organizational objectives.
Things to be aware of when dealing with groups/teams:
• Loyalty to group could become strong enough to cause team goals to supersede
organization goals. In other words, group/team goals are met at the expense of the
organization.
• In-group dynamic could lead to outsiders feeling overly jealous of in-group members.
This could be detrimental to how in-group/outsiders interact in the work environment.
• Possibility of negative norms forming when group is neglected by organization.
• Group think could become an issue in groups with high cohesiveness or in which a strong
leader influences opinions. Nobody wants to be outcaste from the group, so they “hold
their peace.”
Getting past negative aspects of groups/teams:
• Organization should actively seek out group leaders and influence towards organizational
goals.
• Influence leaders to become agents of change.
• Send leaders to training programs so as to increase their formal knowledge.
• Create an atmosphere where asking “what if we are wrong” is okay.
• Have a leaders retreat.
Group leaders exert as much, if not more, power over group members than leaders who hold
legitimate power. Though legitimate power should not be given to every group leader, the ability
to influence employees should be capitalized on through the group leader. In order to do this,
more informational, expert and referent power should be extended to these leaders.

COMMUNICATION:
Communication is the basis of all interactions that take place within the organization.
Communication includes; employee to employee communication, manager to employee
communication, manager to manager communication, organization to employee communication,
organization to customer communication, and organization to organization communication.
However, good communication starts with the leaders.
Leadership:
Leadership is placed under communication because one of the most important aspect of a good
leader is the ability to communicate value, expectations, directions/vision and proper
rewards/punishments. In essence, a leader could be the brightest individual on the earth with the
greatest dream, however if he/she is an ineffective communicator, than nothing will happen.
Change is dependent on communicated vision.
• Transformational leadership embodies the above principal. Since we are an
organization that desires change and constant growth, having a transformational leader
somewhere in the organization is essential. However ,transformation leaders need be
realistic in their ability to listen to feedback to help determine what is or isn’t possible for
the organization.
• Transactional leaders are also important because they are the ones who communicate on
a day to day basis with employees and helps/motivates them to achieve a specified level
of performance.
o Motivation: It is the job of the translational leader to identify what needs
employees have and create environments that sufficiently satisfy these needs.
However, before needs are determined, communication must occur between the
leader and follower to determine at what stage the follower is at. Also, the
manager must clearly explain what the expectations are to meet the set goal.
Also, giving meaningful feedback of employees performance is essential.
o Job Design: It is up to the transactional leader to design jobs in a meaningful
way and then to communicate the description of the jobs to his/her subordinates.
Without proper communication in this direction, subordinates will be confused as
to their roles and will become disillusioned.
o Formal Communication network: Transactional leaders must design the
formal communication paths within their department and create an atmosphere
that enhances the medium of communication and the acceptability of candid
feedback from the messages receiver.
o The grapevine: Leaders should also be aware of the grapevine and how
rumors could be an indication of opportunities or threats.

Communication in the organization:


Communication through-out the organization would rely heavily on technology. Though the staff
is “disjointed,” communication need not be. Reliance on company cell phones, with the ability to
text, live chat boxes and webcams can be used as the substrate of the organizations
communication. This will allow real-time, efficient, and open communication through-out the
organization. A good example of this is how Verizon or AT&T “mobile” employees (like field
techs) communicate large and complex amounts of information through text messaging. The
same principle can be extended to Retina Eye Specialists. Also, a centralized server with
“satellite” connections would allow any patients records to be accessed by any office. This
would centralize information in a way that could allow the above infrastructure to function. One
caveat is the lack of face-to-face feedback.

COMPETITION:
Here is where we truly become a learning organization; or where an organization truly learns and
adapts to changes both internally and externally to the organization. The process is called
Continual Quality Improvement or CQI for short. CQI relies on each member within the
organization to look objectively at their job process and the responsibilities within their scope to
determine how these can be continuously improved. The idea is to not only improve efficiency,
but also value to the customer as well. Here is a proposed CQI model for Retina Eye Specialists:
CQI: Every manager/leader should be trained in this approach.
Stage 1: Use a FOCUS-PDCA approach to CQI. FOCUS-PDCA is a two pronged approach that
requires first the identification of a problem and then action on the problem. FOCUS is the first
step; Find a problem, Organize a team (called task force), Clarify current knowledge, Understand
sources of variation, and Select the process improvement. Once the foundation is set, and the
variables measured and controlled, the PDCA process can take place. This is a cyclical process
that includes Plan, Do, Check and Act. In essence, the team creates a plan, implements the plan,
checks (monitors) the results and Acts on the results if they aren’t as intended
Stage 2: Effectiveness through a Scoring system: Each QI project should be scored using a QI
matrix. The score should be based on the approach, deployment and effect. The scoring system
would be done both by the CQI task force and by the VP in-charge of that department. Only
projects with a 80% or above should continue to be funded. Projects that fall below this mark
should either be scraped or re-worked.
• Approach: Several questions to be answered are: How effective is the approach in
solving the issue? Have other approached been considered? What information is the
approach based on?
• Deployment: Ease of deployment? Would the deployment occur over a short or long
time line? How many departments would be involved? What resources are needed for
deployment? Cost of deployment? Likely acceptance by staff?
• Effect: What is the likely effect? What are contingencies? What are possible fore-seeable
issues? How does this enhance either competitiveness or customer care/satisfaction?
What are the odds of failure/success?
Possible Issues:
• Resistance to change: The idea of constant improvement requires that a person be open
to change. Some people, however, do not like change, and will try to prevent change
from occurring. If these people are able to be added to the CQI cross-functional team, the
process will be better explained, and they will be well informed as to every aspect of the
project. Help influence these people to become agents for change in the small things
before moving them “up.”

CONCLUSION:
Through a CQI approach, utilizing cross-functional teams and groups with electronic
communication and the centralization of a server as the core, the organization can be ever
increasing in its ability to adapt to any changes from within or “without.” This approach allows
for more acceptance of the change, a more organic structure that empowers employees with self-
efficacy, and rewards them with more responsibilities; even without per say a “promotion.” The
over-all structure of the organization itself logically differentiates the major departments, yet still
allows their placement to be flexible and office specific while maintaining over-all
organizational integration.

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