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Parkway Nursing Care is an organization facing a massive change. The company was founded in 1972 with just two nursing homes in Phoenix, Arizona.

Parkway Nursing Care is an organization facing a massive change. The company was founded in 1972 with just two nursing homes in Phoenix, Arizona. The company was very successful, and throughout the 1980s it continued to turn a consistent profit while slowly acquiring or building 30 more units. This low-profile approach 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 southwestern United States, with an average of 115 beds per facility and a total of nearly 30,000 employees. In addition 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 increase. 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 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 neglect 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 Medicare expenses, Parkway may face a reduction in funding. The Problem As growth has continued, Parkway has remained committed to providing dignity and health to all residents in its facilities. The board of directors wants to see renewed 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 focus 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 intentionally negligent—there just are too many patients to see.” A recent college graduate with a B.A. in psychology, 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 because I hurt. And then when I come back, I feel like the rest of the staff thinks I’m weak.” “I started working here right out of high school because 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 another position. But some of the staff just thinks of this as any other job. They don’t see the patients as people, more like inventory. If they want to work with inventory, they should get a job in retail.” Last month, the company’s human resources department 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 medically 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). Year

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