Barbara Norris: Leading Change in General Surgery

The case study “Barbara Norris: Leading Change in the General Surgery Unit” focuses on a new Nurse Manager, Barbara Norris, taking the reins of the General Surgery Unit GSU) with a high turnover ratio.  After conducting an offsite to assess her new situation, Barbara realized that the unit has distrustful staff, limited training opportunities, and a negative culture.  Some of the most pressing issues included a lack of collaboration with staff, absent performance management protocol, and staffing decisions driven by budget cuts.

First, an issue with the GSU is that Senior Staff does not take the time to train newer staff and is visibly bothered by their questions. On the other hand, they speak about the new employees’ performance issues behind their back which creates distrust in the team.  In the article it was noted that “many of the unit’s RNs including both new and more tenured nurses were frustrated with the PCAs and complained that they had inadequate training and skill sets.”  (Groysberg Nohria, Bell, 3) When senior staff complained about the newer staff it fostered a negativity and distrust amongst the team because this feedback was not shared directly with employees.  This culture had an individual focus rather than group effort, and stifled learning and development.  

Instead of learning from seasoned employees, new staff are subjected to a culture of negativity and inadequate training.   In the article, Employee Motivation: A Powerful New Model, a powerful driver for employee motivation is creating a bond and the primary lever behind that is a company’s culture; a company that values collaboration and teamwork will encourage sharing of best practices (Nohria, Groysberg, Lee, 4). Rather than grow the team and the next generation of staff, this culture encourages the opposite: a cycle of turnover and divisiveness.  

Secondly, Staff does not receive consistent feedback daily, or on an annual performance review.  During the offsite Jennifer Goodwin explained that “the review process here is a mystery! As is the annual salary increase. I’ve heard that we all receive the same increase regardless of our performance…” (Groysberg Nohria, Bell, 3) from this statement it appears that staff members do not believe the efforts they are making are noticed or acknowledged by management and senior level staff.  Barbara also faces the challenge of getting to know her new staff member’s histories because the prior leadership did not track reviews consistently.  Additionally, it was inferred that they do not receive compensation that ties directly to their performance. These factors make it difficult to predict what is expected of staff and what will position an employee for advancement in their career.

Finally, the structure of the organization and the services it delivers are based on budget rather than a focus on employee and patient satisfaction.  Before Barbara accepted the position, it was noted that the GSU “…enacted a hiring freeze, stopped all over-time allowance and decreased shift differentials. The administration framed all of these measures within the context of the crisis and for the greater and longer term good” (Groysberg Nohria, Bell, 2).  When changes are made to the structure and the team is made to accept them with little input there is less buy in from staff.  Without a good communication and decision-making process, people are left feeling powerless in how they can positively make an impact in their position with the resources they are given.