One of the most consistent changes in the structure of work over the past few decades has been a shift from a manufacturing economy to a service economy. More workers are now engaged in jobs that include providing care and assistance

Learning Goals
One of the most consistent changes in the structure of work over
the past few decades has been a shift from a manufacturing economy
to a service economy. More workers are now engaged in jobs that
include providing care and assistance, especially in education and
medicine. This work is satisfying for some people, but it can also
be highly stressful. In the following sce- nario, consider how a
company in the nursing care industry is responding to the
challenges of the new environment.
Major Topic Areas
? Stress
? Organizational change
? Emotions
? Leadership
The Scenario
Parkway Nursing Care is an organization facing a mas- sive
change. The company was founded in 1972 with just two nursing homes
in Phoenix, Arizona. The com- pany was very successful, and
throughout the 1980s it continued to turn a consistent profit while
slowly ac- quiring or building 30 more units. This low-profile ap-
proach changed forever in 1993 when venture capitalist Robert Quine
decided to make a major investment in expanding Parkway in return
for a portion of its profits over the coming years. The number of
nursing homes exploded, and Parkway was operating 180 homes by the
year 2000.
The company now has 220 facilities in the south- western United
States, with an average of 115 beds per facility and a total of
nearly 30,000 employees. In ad- dition to health care facilities,
it also provides skilled in-home nursing care. Parkway is seen as
one of the best care facilities in the region, and it has won
numerous awards for its achievements in the field.
As members of the Baby Boom generation become senior citizens,
the need for skilled care will only in- crease. Parkway wants to
make sure it is in a good position to meet this growing need. This
means the company must continue expanding rapidly.
The Stress of Caring
The pressure for growth is one significant challenge, but it’s
not the only one. The nursing home industry has come under
increasing government scrutiny following investigations that turned
up widespread patient abuse and billing fraud. Parkway has always
had outstanding patient care, and no substantiated claim of abuse
or ne- glect in any of its homes has ever been made, but the need
for increased documentation will still affect the company. As the
federal government tries to trim Medi- care expenses, Parkway may
face a reduction in funding.
The Problem
As growth has continued, Parkway has remained com- mitted to
providing dignity and health to all residents in its facilities.
The board of directors wants to see re- newed commitment to the
firm’s mission and core values, not a diffusion of its culture. Its
members are worried there might be problems to address. Interviews
with employees suggest there’s plenty to worry about.
Shift leader Maxine Vernon has been with Parkway for 15 years.
“Now that the government keeps a closer eye on our staffing levels,
I’ve seen management do what it can to keep positions filled, and I
don’t always agree with who is hired. Some of the basic job skills
can be taught, sure, but how to care for our patients—a
lot of these new kids just don’t pick up on that.”
“The problem isn’t with staff—it’s with Parkway’s fo- cus on
filling the beds,” says nurse’s aide Bobby Reed. “When I started
here, Parkway’s reputation was still about the service. Now it’s
about numbers. No one is in- tentionally negligent—there just are
too many patients to see.”
A recent college graduate with a B.A. in psychol- ogy, Dalton
Manetti is more stressed than he expected he would be. “These
aren’t the sweet grannies you see in the movies. Our patients are
demanding. They complain about everything, even about being called
patients, probably because most of them think they shouldn’t be
here in the first place. A lot of times, their gripes amount to
nothing, but we have to log them in anyway.”
Carmen Frank has been with Parkway almost a year and is already
considering finding a new job. “I knew there were going to be
physical parts to this job, and I thought I’d be able to handle
that. It’s not like I was looking for a desk job, you know? I go
home after every
shift with aches all over—my back, my arms, my legs. I’ve never
had to take so much time off from a job be- cause I hurt. And then
when I come back, I feel like the rest of the staff thinks I’m
“I started working here right out of high school be- cause it
was the best-paid of the jobs I could get,” says Niecey Wilson. “I
had no idea what I was getting myself into. Now I really like my
job. Next year I’m going to start taking some night classes so I
can move into an- other position. But some of the staff just think
of this as any other job. They don’t see the patients as people,
more like inventory. If they want to work with inven- tory, they
should get a job in retail.”
Last month, the company’s human resources de- partment pulled
the following information from its records at the request of the
board of directors. The numbers provide some quantitative support
for the concerns voiced by staff.
Injuries to staff occur mostly because of back strain from
lifting patients. Patient incidents reflect injuries due to slips,
falls, medication errors, or other accidents. Certified absences
are days off from work due to medi- cally verified illnesses or
injuries. Other absences are days missed that are not due to
injuries or illnesses; these are excused absences (unexcused
absences are grounds for immediate firing).
Using Organizational Development to Combat Stress and
Improve Performance
The company wants to use such organizational devel- opment
methods as appreciative inquiry (AI) to cre- ate change and
reenergize its sense of mission. As the
chapter on organizational change explains, AI proce- dures
systematically collect employee input and then use this information
to create a change message every- one can support. The human
resources department conducted focus groups, asking employees to
describe some of their concerns and suggestions for the future. The
focus groups highlighted a number of suggestions, although they
don’t all suggest movement in the same direction.
Many suggestions concerned schedule flexibility. One
representative comment was this: “Most of the stress on this job
comes because we can’t take time off when we need it. The LPNs
[licensed practical nurses, who do much of the care] and orderlies
can’t take time off when they need to, but a lot of them are single
parents or primary caregivers for their own children. When they
have to leave for child care responsibilities, the work suffers and
there’s no contingency plan to help smooth things over. Then
everyone who is left has to work extra hard. The person who takes
time off feels guilty, and there can be fights over taking time
off. If we had some way of covering these emergency absences, we’d
all be a lot happier, and I think the care would be a lot
Other suggestions proposed a better method for communicating
information across shifts. Most of the documentation for shift work
is done in large spiral notebooks. When a new shift begins, staff
members say they don’t have much time to check on what happened in
the previous shift. Some younger caregivers would like to have a
method that lets them document patient outcomes electronically
because they type faster than they can write. The older caregivers
are more commit- ted to the paper-based process, in part because
they think switching systems would require a lot of work.
(Government regulations on health care reporting re- quire that any
documentation be made in a form that cannot be altered after the
fact, to prevent covering up
abuse, so specialized software systems must be used for
electronic documentation.) Finally, the nursing care staff believes
its perspec- tives on patient care are seldom given an appropriate
hearing. “We’re the ones who are with the patients most of the
time, but when it comes to doing this the right way, our point of
view gets lost. We really could save a lot of money by eliminating
some of these un- necessary routines and programs, but it’s
something management always just says it will consider.” Staff
members seem to want some way to provide sugges- tions for
improvement, but it isn’t clear what method they would prefer.

Injuries per Staff Member

Incidents per Patient

Certified Absences per Staff

Other Absence per Staff

Turnover Rate







































































Your Assignment
Parkway has taken some initial steps toward a new direc- tion,
but clearly it has a lot of work left to do. You’ve been brought in
as a change management consultant to help the company change its
culture and respond to the stress that employees experience.
Remember to create your report as if for the leadership of a major
When you write your recommendations, make sure you touch on the
following points:
1. What do the data on employee injuries,
incidents, absences, and turnover suggest to you? Is there rea- son
for concern about the company’s direction?
2. The company is going to be making some
signifi- cant changes based on the AI process, and most change
efforts are associated with resistance. What are the most common
forms of resistance, and which would you expect to see at
3. Given the board of directors’ desire to
reenergize the workforce, what advice would you provide for
creating a leadership strategy? What leader behav- iors should
nursing home directors and nurse su- pervisors demonstrate?
4. What are the major sources of job stress at
Parkway? What does the research on employee stress suggest you
should do to help minimize the experience of psychological strain
for employees? Create a plan for how to reduce stress among
5. Based on the information collected in the
focus groups, design a survey to hand out to employees. What sort
of data should the survey gather? What types of data analysis
methods would you like to em- ploy for these data?

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