Running head: SW 4020 Organizational analysis

SW 4020 Organizational Analysis

Caitlin A. DeMara
Wayne State University School of Social Work

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Abstract

This Organizational Analysis covers personal observations, face-to-face interviews, scholarly

research, a SWOT analysis, and organizational theories to come up with an understanding of
Residential Home Health and Hospice as an organization in the field of social work.
Collaborative efforts of patient care teams, field professionals, and administrative professionals
are analyzed in regards to the organizations mission statement and listed goals as an effective
agency in regards to patient care and employee satisfaction.
Keywords: organizational analysis, agency, hospice, organization, analysis, end of life,
social work

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SW 4020 Organizational Analysis

The accumulation of a SWOT analysis, face to face conversations, empirical research,

information obtained directly from the agencys marketing materials and website, and
observations in the field allowed for an organizational analysis to be put together regarding
Residential Hospice and Home Health located in Troy, Michigan. This organizational analysis
will primarily focus on the hospice sector of this organization, which is the newer of the two
sectors and the portion of the organization that I currently serve.
Organization and Services
Organization
The organization of study is Residential Home Health and Hospice which is a private,
for-profit agency that has locations and services in both Michigan and Illinois; the main office
running out of Troy, Michigan. Residential Home Health and Hospice is broken into two separate
businesses underneath their organization name. These two businesses can be broken down into
in-home skilled nursing and therapy (home health) and expert medical care, pain management,
and emotional and spiritual support (hospice). This organization generates their own revenue
through billing for patient care. They have a constantly increasing census and have support from
the Graham Holdings Company, where Residential Hospices highest executives work on their
board to help provide input and feedback regarding the next moves of the organization. The
primary focus of this analysis will serve the Residential Hospice sector of the organization,
where I am assigned as an intern in the Volunteer Department.
Services
The organizations work deals with comfort care, end of life care, bereavement (also
known as grief and loss) education and services, and palliative care; which medically reduces the

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violence of a disease without any intentions of curing it (Merriam Webster Medical Dictionary,
2015). Residential Hospice commits themselves to providing a higher level of patient care
through in-home consultations with patients and families to help them better understand their
options and benefits through hospice, providing access to nursing 24 hours a day year round,
access to a medical social worker that can help ensure patients and families receive services and
support they need, medical directors who are board-certified in hospice and palliative care,
hospice and palliative care certified nurses and aids, and spiritual care counselors to support
patients and families while they also identify pre- and post-grief needs of individuals. Aroma,
massage, and music therapists can also be available upon referral from the other hospice care
team professionals if those services are deemed appropriate. The agency also relies on volunteers
to make companionship visits, run administrative tasks within their offices, and other additional
duties as assigned and needed. Residential Hospices objective is caring, not curing, helping
patients and families focus their energy on the things that matter most (Residential Hospice,
n.d.).
This organization has many moving parts, departments, and individuals working towards
their main goal: easing the burdens of the dying and grieving process for patients, caregivers,
families, and friends. Hospice programs by their very nature involve interdisciplinary
collaboration and coordination (Wright & Bronstein, 2007). The agency employs various
professionals like massage and aroma therapists, grief counselors, after hours teams, social
workers, and volunteers, to name a few, to keep this agency working most effectively as a patient
service agency and a for-profit business. See attached photo of organizational map for details on
these individuals.

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My Role
My role within Residential Hospice is through the Volunteer Department under Lindsey
Sheets and Mary Parmentier (see attached organizational chart). As an intern, my job description
falls under volunteer even though I have more access and am held to a higher standard than a
normal volunteer within the agency would. Volunteers relieve caregivers and frequently help in
the office with mailings and other projects. Volunteers at this agency also make comfort quilts for
patients and memorial quilt squares in remembrance of each familys loved one who received
care from the organization (Volunteers are the Heart of Hospice, 2013). As an intern, I take on
those duties but on a more advanced and professional level. I am able to shadow a Medical
Social Worker in the field, make client visits and put in my own coordination notes for the care
team to read, work special events like remembrance ceremonies and group therapy, and make
vigil visits, which means to sit bedside of an actively dying patient so they are not alone during
their transition. As an intern, I also get to sit in on biweekly Interdisciplinary Group Meetings
(IDG) which brings the entire care team together (a care team includes a primary care physician,
registered nurses, social workers, chaplains and other spiritual care professionals, massage and
music therapists, home health aides, volunteers, interns, and administrative professionals). This
meeting is used to go over each patient and their current presenting case, make changes to their
Plan of Work, write new orders, and validate whether or not they are still appropriate for hospice
service. My role during this meeting is to help run reports on the computer, present on current
patients when applicable, observe the care team, and educate myself on the different aspects of
hospice and patient care.

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Mission and Goals

Mission
We aspire to be the leading provider of hospice services for people in Michigan and
Illinois with a life-limiting illness. We are committed to equipping our highly trained and
dedicated employees with all of the resources necessary to provide extraordinary care and
service;
Residential Hospice provides an individualized program of physical, emotional, spiritual,
social, and practical care for people in the last phases of a life-limited illness, with an
emphasis on control of pain and other symptoms. The program is reflective of a spirit and
idea of caring that emphasizes comfort and dignity for the dying, making it possible for
them to remain independent for as long as possible in familiar surroundings. Hospice care
is centered on both the patient and family/caregivers. Hospice personnel respect and
respond without discrimination, to the unique differences in patients and
family/caregivers and their lifestyle, values, and wishes;
Utilizing an interdisciplinary group approach of physicians, nurses, social workers,
homemakers, hospice aides, volunteers, spiritual counselors, bereavement counselors,
and others. Residential Hospice provides palliative care (in the setting of patient choice),
short-term inpatient services, mobilization, and coordination of ancillary services, and
bereavement support. Services will be equitably distributed to a medically and financially
diversified group of patients in a cost effective manner, which ensures adherence to the
goals of Residential Hospice and the maintenance of the financial solvency of the
organization (Residential Hospice Mission, n.d.).

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Goals

The philosophy, mission, and a purpose of the hospice program will be reflected in the
referral, admission, and services policies and will demonstrate the ability to:
o Establish a commitment to the concept of hospice care
o Provide comprehensive, competent, quality care
o Deliver timely end-of-life care that is well coordinated, family-centered, and
includes bereavement and counseling support
o Case manage and design services that are consumer-oriented and outcome-based
o Ensure continuity of care, consistent with the needs of the patient and
family/caregiver, as it pertains to the terminal diagnosis, culture, environment,
and appropriate level of care
o Acknowledge without discrimination the dignity, comfort, and choices determined
by the patient and family/caregiver, including the election of the Medicare benefit
or alternative health care options
o Design treatment protocols and interventions consistent with the philosophy,

mission, and purpose of the organization;

The philosophy, mission, and purpose of the hospice will be supported through the plan

of care and implementation and evaluation of services;

The philosophy, mission, and purpose of the hospice will be reflected at each level of

care implemented in the care of patients;

The mission statement is made available upon request to patients, referral sources, and
other interested parties (Residential Hospice Mission, n.d.).
[Goal Achievement]. I believe that the organization is achieving the goals they laid out

for themselves. Based on interviews, the SWOT analysis, and my weekly observation of the
workings of the agency, I believe that the goals are reiterated to staff and consumers frequently.
The employees of this organization are able to effectively communicate the ideals of their
mission to prospective clients, facilities, and other professionals. I believe that the mission of this
organization is not displaced in its goal achievement because of the streamlined services that are

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provided by the organization. Though hospice service does include many things that stray from
the initial mission (things like obtaining outside resources, veteran services, and miscellaneous
tasks that help promote a comfortable and healthy environment for the patient and
family/caregiver), there is a very strong underlying motive of compassionate end-of-life care.
The biweekly IDG Meetings allow for the care team and other staff to not only strengthen their
understanding and working of the organizations mission, but it allows them to therapeutically
talk about problems and feelings that have risen in the field. These things can then be addressed
before they have an opportunity to stray from the mission and the goals of the agency.
[Organization Influences]. I believe that the organization is influenced by the people that
work within it most of all when it comes to the facilitation of their mission and goals. If the
employees and volunteers of this agency do not promote the mission and services of the target
population, those facing life-limiting illness, the organization would cease to function at the high
level that it is right now. The Chief Executive Officer, Mike Lewis, keeps the mission and goals
of Residential Hospice in mind with every decision he makes on behalf of the company and the
words he speaks to others about the company, especially to those that work beneath him (S.
Morgan, personal communication, February 8, 2016). His strong leadership at the top trickles
down to the employees, which then in turn affects the work done in the field in a beneficial way
conducive to the organizational goals.
Organizational Structure and Staffing
The distribution of power and control in this organization can be described in reference to
the attached Residential Hospice Organization Chart from 2013. The agency has an accreditation
renewal every three years through the Community Health Accreditation Program (CHAP). This
provides Residential Hospice with an accreditation as a hospice agency in both Michigan and

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Illinois. CHAP defines and advances the highest standards of community-based care and deem
authority granted by the Centers of Medicare and Medicaid Services. The organization chart
allows these accreditations to understand the staffing and structure of the organization, but this
tool is also important for those within and outside the organization in understanding their roles
within the bigger picture and seeing how the organization accomplishes its work.
Residential Hospice employs approximately 110 employees that service approximately
160 patients in Michigan and approximately 50 patients in Illinois (S. Morgan, personal
communication, February 8, 2016). The agency is split up between administrative employees and
employees that work from the field. These lines do overlap and both roles involve aspects of the
other, but for the most part there is a division of labor between face-to-face patient contact and
in-office work. The CEO, President, Executive Assistant, Vice President of Clinical Operations,
Business Development Manager, Director of Sales, Medical Director, Hospice Manager,
Operations Manager, Business Development Manager, Senior Sales Associate, Director of
Quality, Quality Assurance, Clinical Supervisor Registered Nurses, Scheduling Coordinator,
Scheduler, and Bereavement Coordinator positions are known mostly to work in the office.
Registered Nurses, Medical Social Workers, Spiritual Care Counselors, after hours Registered
Nurses and Licensed Practical Nurses, Aides, Homemakers, Music Therapists, Massage
Therapists, Aroma Therapists, and Physicians work mostly in the field. The Volunteer
Coordinators, volunteers, and interns work both positions. As mentioned previously in this
analysis, my role within the agency is underneath the Volunteer Department, so I have access to
in office and field work on a weekly basis.
Distribution of power and control in the organization trickles down from the higher
positions in the administrative, in-office side of the staffing. Management assigns and dispatches

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field workers to cover patients in various geographic locations and are then assigned to specific
case teams. In-office management also assigns on-call duties and any new referrals and tasks as
they come about throughout the day. Occasionally, misunderstanding of the stressors of
caseloads can cause upper management to over-assign tasks and patients to the field workers.
The separation of in-office employees and field employees becomes clear in these moments.
Field employees often become overwhelmed and irritated when they are assigned additional
tasks when already struggling to juggle their caseloads in the field. Dawn Fortner, a Medical
Social Worker, alluded to this stress by saying workload isnt based on the numbers of patients
we are assigned, it is based on all of the other variables like family units, needs for resources,
need for more one-on-one attention, etc. (D. Fortner, personal communication, February 10,
2016). Dealing with the vulnerable population of aging and dying peoples, it is often hard to
gauge how long a visit will take and what a patient and their care network will need on any given
week. The field stuff does a great job in not letting it affect how they work with their clients, but
tensions and stress levels do arise in their actions with one another in the field and in the office,
which can hinder their ability to work effectively with one another. Though field workers feel
supported and have the resources they need provided by the company, it is often hard for the
office staff to empathize with the realities of field work.
In terms of diversity at the different levels of the organization, the predominant
population is Caucasian females. Though there are male field workers, this agency is
predominately female focused, as is the field of social work in general. From my own
observation, I know of one publically gay employee in the call center. My time spent in the
organization has allowed me to come to the conclusion that it is a safe and inclusive
environment, I just dont know many of the employees well enough to know about their sexual

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orientations. The majority of employees are Caucasian, but there is still a population employed
by the organization of People of Color. In my experience, these individuals are treated no
differently because of this, but there are many employees and department I have not personally
worked with.
The diversity of the population served is a lot greater. The hospice patient population
ranges in age, race, orientation, background, socioeconomic status, and some are a part of a subpopulation like veteran, deaf and/or blind, those with a mental illness diagnosis, those suffering
with substance abuse problems, etc. The population of employees at Residential Hospice is well
versed in many areas and attends various trainings to remain and become more culturally
competent. The employees of this organization also support one another and share resources and
personal knowledge to ensure each patient has an individualized Plan of Care. Though the
employee population is not as greatly diverse as the population they serve, they are adequately
equipped to work with the population nonetheless.

Theoretical Construct of Organization

I believe the neo-classical organizational structure theory best sums up the type of
management and structure this agency works with. It involves the study of attitudes, behavior,
and performance of individuals and groups in organizational settings. This approach came to be
known as behavioral approach. It is extended and improved version of human relations
movement (Sarkar, 2013). The human relations movement evolved as a reaction to the tough,
authoritarian structure of classical theory. It addressed many of the problems inherent in classical
theory. The most serious objections to classical theory are that it created over conformity and

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rigidity, thus squelching creativity, individual growth, and motivation. Neoclassical theory
displayed genuine concern for human needs (Sarkar, 2013). The creation of neo-classical
organization theory sought to create a comprehensive theory of behavior in organizations that
was centered on the need for people in organizations to cooperate (Regina, 2012). This
approach allows for decision-making for the agency to be a collaborative
effort amongst departments and staff. The organizations culture revolves
around creating better systems to best effectively manage caseloads,
documentation, individual patient care, and care team satisfaction and
support.
In a face-to-face interview with Shannon Morgan, the Director of Regulatory and Quality
Assurance, management goals were discussed. Morgan stated that the organization is not afraid
to spend money in areas that would greater benefit the employees (S. Morgan, personal
communication, February 8, 2016). An example of this is the purchasing of software to allow
registered nurses to stage the severity of wounds while in the field. The company recently
invested in new software for the documentation tablets that all care team members carry with
them in the field. This software allows for nurses to take a photo of a wound within this program;
the program then stages the wound and documents any necessary information directly to the
charting system the company uses, called Homecare Homebase. This not only saves time in the
field for the nurses, but it makes sure there is consistency and validity when charting and staging
wounds across many different patients and professionals. New systems like this one shows that
the organization is very focused on creating a good quality of work for their employees and are
very human relations based.

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Residential Home Health and Hospice was recently bought by Graham Holdings, a longterm investment company that invests in a diverse group of businesses sharing common goals
and values but each with its own identity and workplace culture, and with management
responsible for its operations (Graham Holdings, n.d.). Both Residential Hospice and Graham
Holdings believe in investing in their employees and taking risks to further innovate and seek
potential for growth and employee satisfaction (S. Morgan, personal communication, February 8,
2016).
This organizational theory can help an outsider to better understand the organization in its
explanation of the importance of employees, team morale, and cooperation amongst team
members to meet the organizations mission and goals. Hospice, by definition, is a team-oriented
care program. Without the cooperation, satisfaction, motivation, and drive of its employees, the
services rendered would be sloppy and incomplete. When working with the aging and dying
population, there is no room to fix mistakes. There is not an abundance of time in these cases,
therefore things need to be facilitated correctly the first time. Neo-classical management allows
for the upkeep of employee satisfaction, care, and support to prevent any holes in cooperation
and service by the agency.
Residential Hospice also follows the organizational theories and guidelines of the
National Hospice and Palliative Care Organization (NHPCO). The pathways to success for
organizational excellence include having staff devoted to organizational excellence, ethics
committee involvement, and attending to the culture to create an environment of excellence
including innovation and giving purposeful attention to and management change needs
(Organizational Excellence n.d.). NHPCO focuses on building a culture of quality and
accountability within the organization that values collaboration and communication and ensures

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ethical business practice (Organizational Excellence n.d.). Residential Hospice seems to be

following these NHPCO guidelines and theories, but can make moves to improve (see
Recommendation section).
Internal and External Environment: Relationship with Community
Residential Hospice has a strength in innovating and creating programs that allow for
potential for growth of the business and employee satisfaction. The owners are not afraid to
spend money on technology and software that will allow for more efficient fieldwork,
compliancy, accuracy, and consistency. One of the main goals is to create ease in the field for the
clinician (S. Morgan, personal communication, February 8, 2016).
Weaknesses of the organization can be found in their orientation program. This weakness
is not only spoken of by the Quality and Assurance Manager, but also by other field workers.
Their lack of a solid, professional, and consistent orientation program creates job dissatisfaction,
lack of confidence with new staff, inconsistent nurse documentation, and frustration amongst the
field professionals. The company in turn gets blamed for all of these issues. This weakness has
been identified, and a Clinical Educator has been hired to create a strong and consistent program
to fix this problem and turn this weakness into an organizational strength.
Opportunities that face the organization can be found in new for-profit avenues and ways
to reach the community, gain referrals, and educate the population on end-of-life and hospice
care. The other side of the business is the Residential Home Health sector of the organization that
can help deem some of their home patients as being hospice appropriate. These patients are then
referred to Residential Hospice for service. Residential as a business also has a nurse that works
between the Home Health and Hospice sectors of the organization to help transition patients
from one side of care to the other. An external trend that affects Residential Hospice is the need

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hospitals have to curb outpatient and emergency room visits. Hospitals refer patients who have
chronic hospital visits due to life-limiting diagnoses. Sales representatives from the organization
work with hospitals and other health care institutions to educate their employees and gain their
trust to receive referrals.
Lack of education and community in hospitals and doctors offices are an active obstacle
and threat faced by this organization. Often, patients are referred to hospice when it is too late
and there isnt enough time for the patient, their family, and other caregivers to benefit from the
services and support that Residential Hospice can provide. Another threat to the organization is
the tunnel vision of healthcare professionals to focus on curing and keeping patients alive.
When too much focus is given on that during times of terminal illness, the patient and their
families can ultimately suffer. The problems encountered when establishing hospice care can
revolve around the following issues: the attitudes of care-givers and the public toward the
terminally ill, the lack of knowledge about the needs of the terminally ill patient, the lack of
knowledge about the concept of hospice and how to organize the program, the ability of hospice
to become a part of the health care delivery system, and the establishment of consistent
reimbursement policies (Toot, 1982). Residential Hospice has developed an understanding that if
they do what is right and supply needs with compassion, they can work past these threats. A
threat to the hospice community is caring about money ahead of patient care and compassion;
Residential as an organization doesnt want to lose sight of that reality.
Recommendation
Information compiled from interviews, personal observation, research, and a SWOT
analysis, a problem that I have identified that interferes with the organizations ability to meet
their mission and goals effectively is the disconnect between the administrative staff and the field

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staff. Those these two groups of employees constantly communicate, it is all very superficial and
does not dig deep into problem-solving for the long run. I think that a change that would benefit
the organizations effectiveness would be for each side of the organization to spend time helping
out with the others job. In order to do this, caseloads need to be more simplified. An employee
cannot shadow another employee when they do not have time to first give attention to their own
job and caseload. I believe a baseline understanding of what each professional goes through in
the position will better equip each employee to help understand where the needs and gaps in
service lie.
Unfortunately, my specific change recommendation isnt necessarily realistic with the
way staffing lies at the organization. Caseloads are high and schedules are already almost
impossible to accommodate. In an ideal situation, each member of the care team and
administration would be able to shadow all of the other professionals and have a holistic
approach of the entire agencys work. If anything, a feasible change would be to rework how
employees communicate and understand the roles of one another.
I would expect organizational resistance at first because it would initially be more work
to solve this problem, even if the abundance of work in the beginning would negate problems
and save time in the future. I would propose to handle this resistance by making it clear why
these changes and efforts were taking place and hearing any other recommendations and/or
concerns from those who would be most affected by them. A good way to battle resistance is to
have those involved feel like they are a part of a working group instead of a one-way
conversation.
Another problem that interferes with Residential Hospices mission and goals is the lack
of education throughout the communities and establishments it serves. I believe this can be

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modified by the organization reaching out more through their marketing department to do larger
scale informational sessions. The care team professionals and marketing professionals already do
informational meetings at facilities and with individual families, but I believe if they reached out
to departments in hospitals and other healthcare affiliated organizations, it would have a broader
and more efficient impact. I do believe that this is a realistic solution and could become an entire
new program within the organization if given the correct staffing and resources, which the
organization historically seems to not have problems implementing and investing in.
Conclusion
In conclusion, Residential Home Health and Hospice is a highly functioning patient care
agency with slight systematic problems regarding communication between and understanding
roles of employees within their own environment. This organization is aware of its own strengths
and weaknesses and works to improve both of them to better serve their working and consumer
populations.

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References

Graham Holdings. (n.d). Retrieved from http://www.ghco.com/phoenix.zhtml?c=62487&p=irollanding

Organizational Excellence. (n.d.). Retrieved from http.//www.nhpco.org/quality-10-components
quality-care/organizational-excellence
Merriam Webster Medical Dictionary. (2015). Retrieved February 13, 2016, from
http://www.merriam-webster.com/dictionary/palliative
Regina, M. (2012). Neo-classical organizational theory [Prezi Presentation]. Retrieved from
Lecture Notes Online Web Site: https://prezi.com/yvxr7ktjeocg/neo-classicalorganizational-theory/
Residential Hospice Comfort Care (n.d.). Retrieved February 13, 2016, from
http://residentialhospice.com/
Residential Hospice Mission (n.d.). Retrieved February 13, 2016, from
http://residentialhospice.com/
Sarker, S. I. (2013). Classical and neoclassical approaches of management: An overview. IOSR
Journal of Business and Management IOSR-JBM, 14(6), 01-05.
Toot, Jane Lea. "Hospice Care: The Role of Education in Its Implementation." Dissertation
Abstracts International 44.01 (1982): 19. ProQuest. Web.
Wright, K. N. & Bronstein, L. (2007). An Organizational Analysis of Prison Hospice. The Prison
Journal, 87 (4), 391-407.
Volunteers are the Heart of Hospice! (2013, August 29).

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Assessing Organizations Using a SWOT Analysis

Agency: Residential Home Health and

Student: Caitlin DeMara (EM7651)

Hospice
Date: February 8th, 2016

Interview from Shannon Morgan:

Director of Regulatory and Quality Assurance,
RN
Internal Environment (what organization itself control systems, staff, procedures, process,
policies, practice standards, etc)
Strengths
-Innovation: Owners not afraid to put
money in for potential for growth and
employee satisfaction.
-technology and software efficient
-invests in education-goal to improve
patient care
-new software (ex: software on tablets that
can take photos of a wound, stage it, and
dumps the documentation into the
computer system.) Allows for compliancy,
accuracy, consistency, and ease of clinician.

Weaknesses

Orientation Program: lack of a concrete

program causes poor job satisfaction, low
new staff confidence, nursing specific
documentation is unclear and inconsistent,
causes frustration among care team, company
is blamed for job dissatisfaction.
Weakness has been identified-plan to fix:
hired a clinical educator to own the program
and create consistency.

External Environment (what is outside the organizations direct control economy,

demographics, community trends & needs, funding sources, other organizations, etc)

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Opportunities

New for-profit avenues

New ways for referrals and ways to reach
the community.
Looks at community and competitions
Residential Home Health is a separate
company underneath the organization
umbrella. Allows for home health patients
to be assessed for being hospice
appropriate and then referred to the hospice
side of the organization.
New education and new software helps to
identify hospice eligible patients in
hospitals and other homecare institutions.
Sales representatives educate on advanced
directives, targets, changes in the market,
and regulation changes.

Threats

Threats to the mission include lack of

education in hospitals, communities, and with
doctors.
Patients are often referred to hospice too late.
Doctors want to be a Jack of all trades, but a
master to none and have tunnel vision in
regards to keeping patients alive and curing
patients. Too focused on seeing patients,
giving needs, and not expanding from that.
Competition exists in the market, but
Residential Hospice believed to always be in
front of the competition because they supply
needs with compassion and purpose instead
of focusing on money at the forefront.

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