MMHA 6501 Week 1 Adaptive-Technical Framing Brief Example

Memorandum

To: Administrator, Maple Terrace Health and Rehabilitation

From: Administrator in Training (MMHA student)

Date: Month Day, Year

Re: Three current problems sorted as technical or adaptive, and the leadership response each calls for

The Distinction

Technical problems have known fixes that an expert can apply; once the right person is assigned, the problem is solved without anyone changing how they think about their work. Adaptive challenges require the people involved to change what they value, believe or do, and no expert can solve them on others' behalf (Heifetz et al., 2009). Most of Maple Terrace's problems are labeled urgent, but their urgency tells us little about which kind they are. This brief sorts three current problems and proposes the leadership stance each calls for. Maple Terrace is an invented 120-bed skilled nursing facility with a 60-bed long-stay unit on the second floor and a 40-bed short-stay rehabilitation unit on the first.

Problem 1: The Call-Light Panel on the Long-Stay Unit

The call-light panel at the second-floor nurses' station has failed intermittently for three weeks. When it fails, lights in resident rooms still illuminate, but the station display and pagers do not alert staff, so residents wait longer for help. Maintenance has reset it twice. The vendor has identified a failing circuit board and quoted a replacement.

Sort: technical. The problem has a known cause and a known fix, and the people who use the system do not need to change anything about how they work once it is repaired. The interim risk is real, since residents who call for help may not be heard, but the response to that risk is also technical: hourly rounding on the unit until the board is replaced, documented on a log the charge nurse checks.

Leadership posture: authorize the purchase today, assign maintenance to schedule the repair, and confirm the interim rounding plan with the unit manager. The administrator's job here is to remove delay, not to convene anyone.

Problem 2: Night-Shift Call-Offs

Night-shift call-offs among certified nursing assistants have roughly doubled over four months, leaving both units short on several nights a week and pushing agency use up. Exit conversations with two night CNAs who resigned mentioned a supervisor who criticized staff in front of residents and a sense that night-shift concerns never reached day leadership.

Sort: adaptive. A technical response is available, such as an attendance incentive or a stricter call-off policy, and both have been suggested. But the evidence points to a crew that has stopped trusting its supervisor and does not believe leadership listens. Neither an incentive nor a policy changes that. The people closest to the problem, the night CNAs, their supervisor and day leadership, would each need to change something: the supervisor how she gives feedback, the CNAs whether they raise concerns, leadership whether it is present at night. Turnover among nursing home staff is associated with lower quality of care (Castle & Engberg, 2005), so the stakes extend beyond staffing costs.

Leadership posture: the administrator cannot solve this directly but can create the conditions in which the people involved work on it. That means being present on night shift, listening before proposing, and holding the supervisor's development as a shared problem rather than a disciplinary one. Heifetz et al. (2009) describe this as giving the work back to the people who must change while keeping the pressure at a level they can bear.

Problem 3: Slow Discharge Paperwork on the Short-Stay Unit

Discharges from the short-stay unit have been delayed by incomplete paperwork: medication reconciliation, home health referrals and patient instructions are often finished late in the afternoon, so patients who were ready to leave in the morning go home after dinner or stay another night.

Sort: mixed. Part of the problem is technical. The discharge checklist in the electronic record is out of date and does not match the forms the home health agencies require, and updating it is a task for the nurse educator and the records manager. Part is adaptive. Nurses, therapists and the social worker each see their own piece of discharge as someone else's to start, and the unit's habit is to begin discharge work only after the physician writes the order. Changing that habit requires the team to accept that discharge planning starts at admission, which is a shift in how each discipline understands its role.

Leadership posture: fix the checklist through normal channels and, separately, convene the unit's interdisciplinary team to look at three recent late discharges together. The team, not the administrator, should decide how to start discharge earlier.

The Error Most Likely to Follow

The most likely error is to meet the adaptive problem with a technical fix. The call-off problem is the most expensive of the three, and there is pressure to do something quickly. An attendance incentive or a revised policy would feel like action and might reduce call-offs for a few weeks. But if the underlying problem is trust, those measures will be read by night staff as proof that leadership does not understand them, and the problem will return or worsen. High reliability writers warn that organizations under pressure tend to simplify their explanations of trouble (Weick & Sutcliffe, 2015), and a quick incentive is exactly that kind of simplification. The same risk applies to discharge: updating the checklist will help, but declaring the problem solved once the checklist is fixed would leave the habit of late discharge planning untouched. I recommend that the administrator approve the call-light repair today, attend a night-shift huddle on both units within the next two weeks, and ask the short-stay team to review recent late discharges at its next meeting.

References

Castle, N. G., & Engberg, J. (2005). Staff turnover and quality of care in nursing homes. Medical Care, 43(6), 616-626. https://doi.org/10.1097/01.mlr.0000163661.67170.b9

Heifetz, R. A., Grashow, A., & Linsky, M. (2009). The practice of adaptive leadership: Tools and tactics for changing your organization and the world. Harvard Business Press.

Weick, K. E., & Sutcliffe, K. M. (2015). Managing the unexpected: Sustained performance in a complex world (3rd ed.). Wiley.