The purpose of doing my presentation is to present the findings about the problems faced in parkway nursing care organization and come up with measures to solve them in order to pursue its long-term growth objectives.
SURVEY RESULTS
Parkway's mission is to provide good care to the patients and they have a reputation of providing good service in the beginning time. Presently the scenario is that the Parkway is only focusing on the number of patients. The quality of care matters a lot because the care improvements in parkway decreases drastically per year is clearly pointed out by the patient's relatives and also we can notice in the hospital. Over the years, count in the number of patients is being increasing and through my study I have identified that the patients wants to treated well what they are doing previously, to know their nurse is knowledgeable, they are capable and skilled and component to do all types of care services, to have high quality care 24hrs and especially the staffs and nurses to have a caring and human attitude to make the patients as well as them self safe and comfortable.
The survey results clearly shows out that every year the number of patients will be increasing rapidly and the end of the year 2009 it had reach the top most position 25,300.So as per the survey, not only there is increase in the number of patients every year but at the same time, there are other factors like injuries per staffs, incidents per patients, certified absences per staff and other factors also increases, but initially when they started the nursing care they were always more keenly concentrating on the care, to give all types of support to the patients, the nurses and the staffs. And in return the staffs were relaxed in their jobs, they had satisfaction and they treated patients very well.
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FIGURE.1 PATIENTS ADMITED IN PARKWY
FIGURE.2 INJURIES PER STAFF MEMBER
During the year 2000 to 2009 the number of patients increased and at the same time the injuries per staff, incidents per patient, certified absences per staff and turnover rate also increased. So the common thing we can find in the parkway nursing care is they are focusing on the profit not for the patients care .In my point of view because of these reasons they will lose the valued customers as well as the company's reputation will be lost entirely. Even though when the number of patients increases at the same time the management also need to initiate proper methodology to treat patients well and even when the staffs get injured it results in the absence of staffs .some of the staffs injuries are reported and in many of the cases the management hide the staffs injuries so all those are not reported in the hospital register .so it is very difficult to find out who suffers from injuries and who takes leaves. When unexcused leaves are taken by the staffs, management fires badly at them. Many people are not aware of the staffing care what the parkway is giving now they believe that what previous year they were getting, the same care has been provided to them even now.
FIGURE.3 ABSENCE OF STAFF MEMBERS
Now the parkway nursing care centre faces some problems it's because the staffs get aged so the management are forced to appoint new staff members it shows they have to pay more salary to the new staffs and the old staffs doesn't know about the new machines so they always need the help from their sub-ordinates, it shows the hospitals turnover rate variation.
3. PROBLEM IDENTIFICATION
The main problems faced in the parkways are ,
PARKWAY HOSPITAL
FIGURE.5 PROBLEM IDENTIFICATION
Staffing problem
Focus on filling the beds
Documentation problem
Physical demands to the staffs
Staffing problem
This is one of the major issue faced by the hospital when ever the new staffs are appointed, the senior staffs dont give a proper introduction about the hospital,no proper training is provided to them in the probation period. it shows the mis co-ordination between the staffs.senior staffs says the management are only bothered of keeping the positions filled and they even say that basic job skills can be taught,but how to care for patients need to be learned from practice,actually they don't pick on that. so in future it might cause a big problem because the newly appointed staffs are not aware of the hospital environment first and the other factor is they dont have previous year experience.
Focus on filling the beds
In the present days,management's aim is to earn the profit as much as they can, so it decreases their reputation level.The thing is while collecting stones they mis the diamonds it is nothng but the hospital focus in the filling the beds to get more profit.They forget to concentrate on the patient wellness and quality of care.The end result will be bad name to the parkway's reputation.
Documentation problem
After the shift ,the staffs need to enter the work details in a record.so as to go through what had happened in the previous shifts.but this is a very tedious task.In parkway So newly equipped machines,sothrough this electronic machines details could be entered very easily and details entered will be less prone to errors.but the senior staffs are not much aware of these.So again it become a extra work to the staffs.
Physical demands to the staff
This is nothing but when ever the subordinates take leave, it gives more stress to the other staff it also makes problems because they are forced to work from dawn to dusk which will lead to more stress both physically and mentally.
4. CHANGE MANAGEMENT STRATEGY
Resistance to Change
Staffs tend to resist change because of the energy required to adapt, although energy is also required to resist change, or to maintain the status quo. The ability to tolerate change differs in individuals. There are no guarantees that change will lead to a positive outcome. Uncertainty regarding outcome is a major barrier to change.
Because change is inevitable, nurses must learn ways to deal with change. Resistance looks like the individual is rejecting proposed new ideas without critically thinking about the proposal. Nurses must take time to research ideas and make informed decisions as to whether change is worthwhile. The nurse often serves as a change agent, Change agents seek ways to make improvements using critical thinking to develop innovative, creative solutions.
4.1 Forms of Resistance
FIGURE.6 FORMS OF RESISTANCE
Overt and Immediate: Overt changes are obvious and identifiable, and an individual is aware they are occurring. They are usually not under an individual's direct control, such as the restructuring of one's place of employment, but must be adapted to and accepted in order to continue functioning effectively.
Implicit and Deferred: Loss of employee loyalty and motivation, increased errors or mistakes, increased absenteeism.
Individual Resistance: This can be because of selective perception and retention, habit, fear of the unknown, economic factors, uncertainty and insecurity.
Selective Perception and Retention: when employees direct attention to how the change will affect their department, their function, or them personally.
Habit: when employees are comfortable in their daily habits and do not want to alter them due to change.
Uncertainty and Insecurity: this resistance occurs because employees do not know what the outcome of the change will be.
Economic Factors: when in organization, where pay is tied to productivity individuals usually resists change as they fear that they will not be able to perform new task effectively, thus causing a decline in productivity and a decrease in their income.
Organizational Resistance: This resistance includes threat to established resource allocations, threat to established power relationships, threat to expertise, group inertia, limited focus of change, structural inertia.
Threat to power: when a change may benefit one department within the organization while harming another department within the organization.
Group Inertia: Sometimes, the individuals resist change because the group to which they belong resists it. The degree and force of resistance will depend upon how loyal one is to the group and how effectively the group resists the change.
Threat to Expertise: Change in organization may threaten the expertise of specialized groups.
Threat to Established Resource Allocations: Organizations need adequate financial resource for training change agents and for offering rewards to those who support change. An organization that does not have resources for implementing the change resists it.
Structural Inertia: Change is often resisted by the bureaucratic structures where jobs are narrowly defined, lines of authority clearly spelled and flow of information is stressed from top to bottom.It will shows the complete structure of the resists
4.2 Resistance in Parkway
Resistance is an inevitable response to any major change. Individuals naturally rush to defend the status quo if they feel their security or statuses are threatened. The following are the Resistance in parkway that I felt in my study:
A better approach for communicating information across shifts. Documentation for shift works is usually done in large spiral notebooks. When a new shift begins, staff members don't have much time to check on what had happened in the previous shifts. So the young caregivers opt for electronic documentation, because it is much faster than writing and will also be less prone to errors. But the old caregivers are still committed to paper-based process. In part, because they think switching systems would require a lot of work. This may be the reasons for old caregivers to resist change.
The young caregivers resist change may be because of lack of trust, communication among all colleagues in parkway, fear about their jobs, security, and their desire to retain friendships.
When new technologies are introduced, and if the staffs are not much aware of that technology, it leads to dissatisfaction in the work and staffs feels insecure about their jobs and this could also be the reasons to resist change.
4.3 Overcoming Resistance in Change:
Education and Communication
Education and communication help employees see the logic of the change effort. It can be assumed that much of the resistance lies in misinformation or poor communication. One of the best ways to overcome Resistance to Change is: to inform and educate people about the change effort. This reduces unfounded and incorrect Information.
Participation
Participation in the decision process lessens resistance. Participation involves in bringing those individuals directly affected by the proposed change in to the decision-making process. It also allows expression of feelings, increases the quality of the process, and increases employee commitment to the final decision.
Building Support and Commitment
The basis of resistance to change is likely to be: the perception that there will be some form of detrimental effect occasioned by the change in the organization. This can be supported by counselling, therapy or by giving new-skills training. It also involves in helping employees to deal with fear and anxiety associated with the change effort.
Implementing Change Fairly
Implementing organizational change is a difficult and critical task. Whether the change is being forced by external issues or being brought about internally by leadership decisions it needs to be implemented consistently and fairly.
Manipulation and cooptation
Manipulation and cooptation refers to covert attempts to influence others about the change. It may involve twisting or distorting facts to make the change appear more attractive. The effective manipulation technique is: to co-opt with people who are resisting the people who are resisting the change, to participate in the change effort.
Selecting people who accept change
Give priority to the people who enjoy the change. It is a very important need for organizations to recruit and select people capable not only to bring or initiate but, also, handle change effectively.
Coercion
Coercion involves the use of direct threats or force against resisters. Managers can explicitly or implicitly force employees in to accepting change, by making clear that resistance to change can lead to: job losses, dismissals, employee transfers, or not promoting employees.
5. KOTTER'S EIGHT-STEP PLAN
To cope with new technological, competitive, and demographic forces, leaders in every sector have sought to fundamentally alter the way their organizations do business. Kotter has identified eight critical stages of successful change management. Mismanaging any one of these steps can undermine an otherwise well-conceived vision.
Establish a Sense of Urgency
Inspire people to move, make objectives real and relevant.When the job stress increases the staffs have a tendency to shift the other property where they get some good and comfortable stay.
Form a Powerful Guiding Coalition
Get the right people in place with the right emotional commitment and the right mix of skills and levels. Assemble a group with enough power to lead the change effort. Encourage the group to work as a team.The management is strong obviously the subordinate have a feelings to do their job in a systematic manner.Here the coordination and corporation is the important thing.
Create a New Vision
Get the team to establish simple vision and strategy focus on emotional and creative aspects necessary to drive service and efficiency.The visions are segregated into different small parts and solve one by one each other so it is easy to do and the organization have achieve their goals.
Communicate the Vision
Involve as many as people as possible, communicate the essentials, simple, and to appeal and respond to people's needs. De-clutter communications-make technology work for you rather than against.
Empower Others to Act on the Vision
Remove obstacles, enable constructive feedbacks and lots of support from leaders-reward and recognise progress and achievements.The staffs did a good job means appreciate them and to provide promotion.The staff become happy and get a motivation in their mind to do the work more.
Plan for and Create Short-Term Wins
Set aims that are easy to achieve- in bite-size chunks. Manageable numbers of initiatives. Finish current stages before starting the new ones. First go for the short term win then after go for the long term .Achieve small goals first in the parkway find out what are the drawbacks ,study in detail and make a chart to solve the problems.
Consolidate Improvements and Produce Still More Change
Foster and encourage determination and persistence. Encourage ongoing progress reporting and take a clear view of that. Highlight achieved and future milestone.Dont think about the past go through only the present and future achievement.
Institutionalize New Approaches
Reinforce the value of successful change via recruitment, promotion, and new change leaders. Weave change into culture.When the time of selecting an employee or equipment the person who is in charge to the category must know about the details about the particular thing.
6. IMPLEMENTATION
Leaders play a vital role in an organization. Leadership is the art of motivating a group of people to act towards achieving a common goal. Leaders have vision; they are not just for themselves, they set a common goal and give direction to their followers. When difficult situations arise, leaders provide guidelines of what to do in present scenario.
6.1 Creating a Leadership Strategy
The ability to implement strategies in an organization is one of the most especially the skilful managerial requirements and moreover the knowledge that we need in some of the critical situation to run an organization. The core aspects of strategies are to sustain a competitive advantage on other organizations. Organizations must acquire and utilize technique to optimize their core competencies, to strengthen the basic structure of organizational capability. Among this strategies, managers are the person at all time should be involved in implementing on the set strategies they have a vital role in the organization. Strategic implementation entails the transformation of an organization strategies plan into action and ultimately into a result, preferably high performance results. The strategies of an organization are required to increase its capacity to compete on the basis of its intellectual competencies, which has been strategically aligned with the objectives the organizational has on its own goal achievement.
Drivers are the key choices that leaders make about how the organisation has to take the advantages for the making of its strengths, weakness, opportunities and threats in the organisation. For regarding the things in the form of leadership strategy that make a strategy in a unique position to one organization as compared that to another and dictate where tradeoffs will be made between alternative investments of resources, time and energy. Drivers are few in numbers in the organization and help us understand what it is absolutely essential for leaders and the collective leadership of the organization to accomplish.
Leaders and managers in an organization play a vital role they can be used by some of the factors to create a healthy organizational culture, such factors are social factors, physical setting, technology, organizing arrangements and individual behaviour. Leaders and managers are required to have increased resources, perceptive knowledge, and superior talent and enhanced capabilities to continue facilitating processes toward attaining the ultimate objectives, discovering and commercializing safety of the organization. These multiple activities require managers and leaders who have the significant of strategies implementation and core competencies and organizational capabilities that create values to changes of the organization.
The management is responsible for establishing systems and procedures which facilitate effective and smooth running of an organization. They set up controlling systems and procedures which are used to ensure that the organization is controlled and disciplined. Management ensures that the organization that the rules set up is adhered to for the organization to function optimally. The management process includes heading and leading the management, organizing the management and planning how to handle the management. The leadership of a company mainly involves establishing direct and creating a vision for the company. It involves modelling the vision, forming teams, influencing them and aligning people to achieve the set goals. Leadership bears the responsibility of inspiring people and producing meaningful changes in the company. Leadership is therefore responsible for positioning people and organizations for useful change. Therefore it ensures that the company does the right, in its strategies. Leadership requires are sound understanding in order to create goals and vision of the company and work towards achieving them. Good leadership entails the ability to articulate a vision, align the people's talents and efforts of the company's direction and keeping them focused on the set vision by motivating and inspiring them.
6.2 Recommended Leadership Style
There are mainly three types of leadership styles. In parkway it is apt to use democratic leadership style. This style is also called participative style as it encourages employees to be a part of the decision-making. The democratic manger keeps his or her employees informed about everything that affects their work and shares decision-making and problem solving responsibilities. This style requires the leader to be a coach who has the final say, but gathers information from staff members before making a decision.
Democratic leadership can produce high quality and high quantity work for long periods of time. Many employees like the trust they receive and respond with cooperation, team spirit, and high morale.
Democratic leadership style is effective when
The leader wants to keep employees informed about matters that affect them.
The leader wants employees to share in decision-making and problem-solving duties.
The leader wants to provide opportunities for employees to develop a high sense of personal growth and job satisfaction.
To encourage team building and participation.
6.3 Leadership Behaviours of Home Directors
In parkway there are many departments, each having home directors. The home directors act as an interface between management group and supervisors. Effective leaders are required to use problem-solving processes, maintain group effectiveness and develop group identification. They should also be dynamic, passionate, have a motivational influence on other people, be solution-focused and seek to inspire others.
Senior nurses must apply these characteristics to their work in order to win the respect and trust of team members and lead the development of clinical practice. By demonstrating an effective leadership style, these nurses will be in a powerful position to influence the successful development of other staff, ensuring that professional standards are maintained and enabling the growth of competent practitioners.
The home directors should possess the following leadership behaviours making decisions, delegating appropriately, resolving conflict, and acting with integrity. The role also involves nurturing others and being aware of how people in the team are feeling by being emotionally in tune with staff.
6.4 Leadership Behaviours of Supervisors
Supervisors act as bridge between home directors and bottom level management. Supervisor's duty involves a lot of key responsibility and dedication. Nursing supervisors need to be motivated, dedicated within their line of work, team players and team leaders, and have the ability to work effectively with staff and employers alike.
Supervisors must make attempt to listen to the concerns of nurses and incorporate those concerns into actions for change. It is supervisor's responsibility to foster growth and to make nursing processes efficient and evidence-based. Supervisor should serve as a team to engage them and foster positive change within our daily processes, supervisor should lead them in the direction that will encourage individual personal growth and increase positive team collaboration.
7. JOB STRESS IN PARKWAY
As the pace at which our organization operates increases, the pressures for every staffs of organization to keep up with this pace also increase. Prolonged stress, however, has been shown to cause illness and other conditions that can have detrimental effects on a staff's workforce. the increasing rate of stress at work has wide-ranging effects-absenteeism, impaired teamwork, workplace violence, decreased efficiency, increased rates of physical and mental illness, employee burnout, risk of discrimination and growth in early retirement.
7.1 Sources of Stress
The main cause of stress in parkway can be because of
Environmental Factors
For an environment let us talk about the stress environmental uncertainty influences stress levels among employees in an organization. Changes in the business cycle create different economic uncertainties in the environment. Political uncertainties is including one of the major stress. Technological uncertainty can cause stress because new innovations can make an employee's skills and experience obsolete in a very short period of time.
Organizational Factors
There are many causes of stress within an organization including organizational structure, leadership style and quality, the demands of tasks and roles, balancing efficiency of services with high quality standards, the increasing "24/7" mentality, structural changes and changes in business processes, and the quality of communication throughout the organization.
Organizational Change: Change in an organization can cause stress for employees that are unwilling to accept the changes. Such behaviour can then cause stress for their supervisors and co-workers.
Task Design: Tasks that are mundane or unpleasant and a workload that is either too heavy or too light can cause stress in workers. Lack of control over workload and work-pace is also a source of stress.
Management Style: Workplace leaders can cause stress when they classify subordinates' views as unethical, incompetent, or irrelevant. Leaders who do not include staffs in decision-making or who communicate poorly also cause stress.
Interpersonal Relationships: Lack of support from coworkers and supervisors, harassment, and a lack of procedures for dealing with workplace issues are sources of organizational stress.
Work Balance: The emergence of new technologies has lead to a lack of division between work life and social life for some workers and is a source of organizational stress.
Personal Factors
Personal concerns are another top cause of stress. We all have an innate desire for control over our own life. When control is weak or missing in a given area, we experience stress.
To some, a lack of control over their own time is a leading cause of stress. We want to decide when we do tasks around the home, or at work.
Some are stressed from not enough sleep, no time to relax, and no time to discuss some nagging problems.
We may be involved in legal proceedings that cause stress. We may be wrestling with a bad habit. We may be going through changes. Personal change of any kind can be a cause of stress.
Family, as wonderful as each member may be, is also a leading cause of stress. The ebb and flow of family life is filled with stress. Arguments may erupt with a spouse or other family members. Parents divorce. Children marry. A child may move out or an aging parent may move in. A sick family member, a serious injury, pregnancy, miscarriage, or abortion all cause stress. Family changes of other kinds bring stress, too. Adoption, relocation, and job changes for just one family member can cause stress for all.
In addition, staffs in parkway also face stress: the first reason for this is schedule flexibility, the staff members can't take time off when they need to. When staffs need to take emergency leave for childcare responsibilities or for other personal reason, the work suffers and there is no contingency plan to help smooth things over and the remaining staffs who is left has to work extra hard. The staffs who take time off feel guilty, and there can be fights over taking time off. Unexcused absences taken by staffs will have to undergo immediate firing from their heads. The second reason is in the case of documentation, since the details of the previous shifts are entered in large spiral notebooks, staffs don't have much time to check on what had happened in the previous shifts. These lead to conflicts and thereby cause stress. Third reason is, when a new technology is introduced or when management come up with new decisions and if the staffs are not much aware of that, this leads to stress. The fourth reason is, old caregivers have the opinion that the young caregivers who are hired don't pick on how to care for patients this in turn cause workloads on senior staffs. The fifth reason is, since management is focused on filling beds and there is also increase in number of patients every year, the workload on staffs are extremely high such that they don't even have time for a taking small breaks during their work time.
7.2 Actions Required
There are two major approaches to reduce stress
Individual Approach
Organizational Approach
Individual Approach
An employee can take individual responsibility to reduce his/her stress level. Individual strategies that have proven effective include, implementing time management techniques, increasing physical exercise, relaxation training, and expanding the social support network.
Time Management
Good time management is a very essential factor in reducing stress. Planning time allows you to spread work over a session, avoid a jam of work, and cope with the stress. Many people manage their time very poorly. Some of well known time's management principles include prioritise the tasks, making daily list of activities to be accomplished, and scheduling activities according to the priorities set, prioritizing activities by importance and urgency, knowing daily cycle and handling the most demanding parts of the job tasks.
Physical Exercise
Many people exercise to control weight and get in better physical condition to become more healthy or physically attractive, but exercise and stress management are also closely linked. Practicing non-competitive physical exercises like aerobics, race walking, jogging, swimming, and riding a bi-cycle etc keeps us physically and mentally active. Unhealthy diets and physical inactivity are key risk factors for the major diseases like heart diseases, cardiovascular diseases, obesity etc.
Relaxation Training
The body's natural relaxation response is a powerful antidote to stress. Relaxation techniques such as deep breathing, visualization, progressive muscle relaxation, meditation, and yoga can help you activate this relaxation response. When practiced regularly, these activities lead to a reduction in your everyday stress levels and a boost in your feelings of joy and serenity.
Social Support
When under intense stress, it is very natural to withdraw from the world and concentrate exclusively on solving the problem that is causing the stress. However, this may not be an ideal option. One person working on his or her own simply cannot achieve tasks beyond a certain limit. Similarly, many stressful situations cannot be resolved without the help of other people. As such, learn to be more sociable. Expand and develop own social network of friends so that there are always these groups of people that you feel comfortable with that can help you in times of need. Simple as they may seem, these stress management tips when put into use can greatly help you in managing and coping with stress. Stress should never be taken lightly especially on a long term basis. Acknowledging the presence of stress and dealing with stress as they arise is the only way to lead a healthier and stress-free life.
Organizational Approach
In parkway there need to be a proper stress management plan in order to overcome the stress faced by the staffs in parkway. Several of the factors that cause stress particularly task, role demands and organizations structure are controlled by management. As such they can be modified or changed. Some of the strategies that management want to consider include improved personal section, use of realistic goal setting, redesigning of jobs, improved organizational communication and establishment of corporate wellness programmes.
Certain jobs are more stressful than others. Young caregivers or an external lower of control tend to be more proven to stress. Management should take these facts into consideration. Goal setting and planning helps to reduce stress. It also provides motivation. Designing jobs to give employees more responsibility, more meaningful work, more autonomy, and increased feedback can reduce stress, because these factors give the employee greater control over work activities and lessen dependence on others.
Properly designed jobs and work schedules can help ease stress. Shift work, in particular can cause major problems for staffs, because they constantly have to adjust to their sleep and relaxation patterns. Organizational culture can also be used to manage to manage stress. Organization should strive to foster a culture that reinforces a healthy mix work and non work activities. Increasingly formal organizational communication with employee reduces conflicts. Wellness program, say, employee counselling and proper scheduled training should be given to staffs so that they will be aware of upcoming technologies, management decisions. All these are the better approaches for reducing stress in parkway.
Employee stress is a growing concern in parkway today. So the management need to take necessary actions to overcome stress. Firstly, there must be sufficient number of staffs in parkway so when an staffs need to take an emergency leave there won't be workload on other staffs and there need to have an proper contingency plan to help things go smoothly. Second, to go for electronic documentation. Since it will be faster than writing and number of mistakes that would happen will be less. Third, the old caregivers are more committed to paper-based process so they need to have training about electronic documentation Also sessions on new decisions made by the management, and about new technologies. Fourth, the management should either organise monthly or weekly meetings between management and staffs where staffs feel free to share their ideas, concerns, conflicts, problems etc. Through this approach they can create a friendly working environment and even communication becomes strong and will be able to establish good relationships with all colleagues who work in different departments in parkway.
7.3 Stress Management Plan
Organizations and their managers can reduce stress caused by the work environment in a number of ways: team meetings, using proper management techniques, establishing effective communication system, reducing uncertainty among employees, employee assistance programs and wellness programs.
Team Meetings: talking over problems helps individuals feel better about their co-workers. This can reduce the stress they have about their ability or inability to solve problems. Team meetings allow employees to get together and solve problems.
Deep-Sensing Session: in which organizational leaders meet with employees and communicate face-to-face. This approach should not be just a gripe session. But a situation, where problems associated with miscommunication can be cleared up.
Proper Management Plan: Good management plan can reduce stress. For example, a manager can reduce stress related to time or overwork by allowing employees enough time to plan, organise, and complete the tasks they must do.
Leisure time: Rest breaks during the workday can also help reduce stress. All staffs need some time during the day to sit down, to daydream, to fantasize, and to deal with feelings.
Trainings: Training staffs how to cope with stress is important management. Employees can be taught to cope with difficulties and reduce their own tensions. Working toward strong, positive life goals can help staffs overcome small stressful circumstances much more quickly and effectively
Wellness Programs: This focus on the overall employee's physical and mental health. Stress management and prevention is a vital part of wellness programs. Many of the concerns of wellness programs are at least partially stress related. Wellness programs represent a broad-based contemporary extension of stress programs; their focus is concern for employee health and quality-of-life issues.
8. CONCLUTION
Parkway nursing care organization was founded in1972 with just two nursing homes at Phoenix, Arizona. It was one among the top leading nursing care organizations. In the beginning time, management was only focused on the service that they need to provide. The company was successful and it had won numerous rewards for its service. As growth continued, there began to arise lots of problems within the organization. Management should now implement the change to overcome all resistance in order to achieve long-term growth by considering short-term performance.
