Organizational Analysis SW 4020

Organizational Analysis
February 19, 2015
SW 4020 Macro Theory and Practice
Wayne State University School of Social Work
Chelsey Pasha
Ec5994

Organizational Analysis SW 4020

Sometimes we know what we are called to do and sometimes we need guidance along the
way to help figure out what that calling may be. It is our passion that motivates one to do the
things that they do, whether it be donating our personal time to volunteering or spending
countless hours studying material that will help us to get into a certain field that we truly share a
passion for. I had a chance to volunteer my junior year of high school in the Social Work
program at St. Johns Macomb Hospital in the Social Work department. The opportunity allowed
me to have some of the best experiences but it also allowed me to see what kind of social work I
wanted to do. I watched the social workers dedicate countless hours to help the patients, and
engaging with the doctors, nurses and techs to make a team so that things could be accomplished
and the patients needs were always met. I knew from that experience that I wanted to be a
medical social worker, so when it was recommended to me that I go to Karmanos I was elated.
According to the American Cancer Society, in 2015 alone there will be an estimated one
million new cancer cases that are diagnosed and five hundred thousand cancer deaths in the US
(Cancer.org, 2015). The most prevalent cancers in Michigan by site are lung, prostate, breast, and
colon and rectal (Karmanos. Org, 2012). The cancers with the highest mortality rate in Michigan
are lung, colon and rectal, breast and prostate (Karmanos.org, 2012). We all know of someone
who has been diagnosed with cancer at one point in our lives and each step is a battle, but with
the right doctors and treatment the prognosis is almost always good. Karmanos allowed me to
see the day to day struggles of cancer patient who not only faces the battle of fighting cancer, but
to see the patients fighting the battle of finding adequate resources.

Organization and Services

Organizational Analysis SW 4020

In the heart of midtown Detroit rests a hospital dedicated to helping patients with cancer
and to the study of cancer. Karmanos Cancer Institute a non-profit hospital, which works to serve
the needs of each patient who has been diagnosed with cancer. Karmanos Cancer Institute is one
of forty-one national cancer institutes in the designated Comprehensive Cancer Centers in the
United States (Karmanos.org, 2012). In fact, Karmanos is the only hospital in Michigan
dedicated solely to fighting cancer (Karmanos.org, 2012). According to Binachon 2014, men and
women who live in urban areas are more likely at risk for cancer and cancer related symptoms
than any other sub group (Binachon, 2014)
Karmanos cares for more than six thousand patients each year conducting more than
seven hundred cancer-specific scientific investigation programs and clinical trials; the Karmanos
Cancer Center is among the nations best cancer centers (Karmanos. Org, 2012). Karmanos
offers access to more than one hundred cancer treatments that no other local hospital has access
to (Karmanos.org, 2012). Non for profit organizations are made up of a few key points including
the organization being mission driven, governed by a volunteer board of directors, goal to
achieve charitable purposes, the use of profits by an organization, and an IRS designation.
Karmanos serves as a non-profit organization and makes good use of the donations that is
receives annually. Karmanos serves as a one-stop show for its patients. Patients can come in to
receive everything from an annual mammogram to chemotherapy to a hospital stay. The benefit
of being hospital solely based on cancer is that it allows the patients to feel and understand that
whatever issues they are facing it can surely be addressed at Karmanos and nowhere else.
Karmanos also works to help patients who may not have insurance at the time of diagnosis to

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find the best insurance that works for them while the social work department works diligently to
find each patient resources that will benefit them internally and externally.
All-encompassing ambulatory services include the Alexander J. Walt Breast
Comprehensive Center, the Wertz Clinic, Infusion Center, the Joseph Dresner Family Clinic for
Hematologic Malignancies and Stem-cell Transplantation, and the Eisenberg Center for
Translational Therapeutics (Karmanos.org, 2012). Additional service area sites include the
Lawrence and Idell Weisberg Cancer Treatment Center located in Farmington, Hills and
radiation therapy services at the Monroe Cancer Center (Karmanos.org, 2012). The Social Work
department works to provide the patients with the best resources they can. They find placement
for end of life care and place patients in skilled living and nursing facilities. The Social Work
department works diligently to help the patients who are low-income to catch up on delinquent
bills, so that their lights and gas are not turned off. The Social department and Law school at
Wayne State University have teamed up to help promote awareness about Advanced Directives,
Supplemental Security Income and Social Security Disability.

Missions and Goals of Karmanos

The mission statement of Karmanos states that The Karmanos Cancer Institute is a
unique, integrated center of research, patient care and education, dedicated to the prevention,
early detection, treatment and eventual eradication of cancer (Karmanos.org, 2012). The goals of
Karmanos are indicative of the mission statement itself. The hospital and staff work to promote a
positive environment for the patients to receive treatment and the goals of the social work
department state that each patient in Karmanos in assigned to a social worker whether they know

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it or not. The patient will always have someone to help him or her. Karmanos works to reach its
many goals through awareness and hard work. They post weekly eblast online to ensure the staff
is up to date on any new initiatives the hospital has and they promote physical awareness through
out the hospital. Due to the many patients Karmanos sees in a week, unfortunately it is hard for
the doctors to see everyone in a timely fashion. Patients were complaining of long waiting
periods to be seen, sometimes waiting four hours to see one doctor. This is and was unacceptable
for the patients to have to deal with, so the hospital set up a time study that allowed one person
from each department to see what it was like to wait four hours to see a doctor. Unfortunately the
time study did not help get to the root of why a patient must wait four hours to see a doctor. This
is an example of goal displacement, Karmanos has the doctors to accommodate the patients but if
they arent being utilized correctly then it is easy to understand why goal displacement occurs.
Most recently McLaren took over Karmanos and with the new management of the hospital
unfortunately the role of each department supervisor was cut including my boss in the Social
Work department. Cutting staff creates multiple problems and leads to goal displacement as well.
Each department has to work with out leadership or the proper authority to guide them in making
important decisions.
In the fall of 2010, the KCI Patient and Community Education Department, in
combination with a group of University of Michigan Public Health students conducted key
informant interviews (Karmanos.org, 2012). Key informants were selected from the Wayne,
Oakland and Macomb County Health Departments, and community organizations, such as
Gildas Club of Metro Detroit, the Wayne County Breast and Cervical Cancer Program
(BCCCP), the Detroit Area Agency on Aging, the Arab Community for Economic and Social
Services (ACCESS) all programs that interact with Karmanos in the external environment

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(Karmanos.org, 2012). Also interviewed were cancer survivors, from each of the three counties,
who had received treatment at KCI. The interview questionnaire was designed to obtain honest
information regarding the current needs and gaps as well as the strengths and existing advantages
in coordination and deliver of cancer-related services in Wayne, Oakland and Macomb counties
(Karmanos.org, 2012). Awareness of program services, cultural sensitivity, lack of access to
services and customer service were the four common themes identified from the key informant
interviews (Karmanos.org, 2012)
Organizational Structure and Staffing

Karmanos and the DMC are centered around a corporate setting to help the hospital run
more effectively. At the top of Karmanos is the president and CEO. The president has power and
control over the executive decisions. Margaret Diamond a LMSW was just elected the new
president of Karmanos at the end of the 2014-year. Margaret Diamond has control over every
decision that is made in each department and controls who is hired and fired.
Karmanos is run in a top-down effect, but also in a bureaucratic structure. The authority
comes from the top and everyone on the bottom has to follow the orders of the authority above.
Unfortunately this approach does not always seem to work when addressing the staff with issues
or concerns that management may have. Making decisions at the top without addressing the staff
or consumer/patient effects everyone as a whole, because the decisions are not always made with
the input of the staff or patients who face certain issues every day.
The DMC or Detroit Medical Center is in one of the most urban areas in Michigan. The
doctors are made up of all different ethnic back grounds and come from all over to serve the
needs of the patients, however when you go higher up in the authority is where the diversity is

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lacking. The board of directors, CEO, COO and CFO are all of Caucasian descent at Karmanos.
The nurses, Patient Service Representatives, Social Workers, nursing assistants, and
housekeepers as well as volunteers are all highly diversified. The president is a woman, which
proves that gender discrimination is not an issue, but what about the faces of color? Special
issues that people may face who are minority would be job advancements to a better position or a
position of leadership within the organization. Minorities within the organization may also face
the issue of lack of cultural awareness from other staff who may not understand why it is
important for people of color to move up in an organization to positions of power.

Internal and External Environment: Relationship with Community

Wayne State University has a large partnership with the DMC and Karmanos, which
allows law students, interns and medical students to get the hands on learning. Karmanos is
partnered with many different organizations to improve the knowledge of the patients about
understanding the diagnosis as well as support groups for men and women to go and receive
support. Karmanos works with surrounding nursing homes and hospitals including the University
of Michigan Hospital Campus.
The patients at Karmanos come from all over the community, which in my opinion makes
it the best place to learn, because you have patients who come from many different walks of life
who individually have a different story to tell. The Michigan Department of Community Healths
2011 Health Profile Chartbook county data report that the majority of the population in both
Region 2S (Detroit, and Wayne County) and 2N (Oakland and Macomb county) is between the
ages of forty and forty-nine (Karmanos.org, 2012). Women make up the majority of the

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population in both regions (Karmanos.org, 2012). The racial and ethnic allocation in Region 2S,
is approximately fifty percent White, thirty-five percent Black, five percent Hispanic, three
percent Asian and less than one percent American Indian (Karmanos.org, 2012). Working in the
office and back in the infusion center with the different patients I recognized that no matter what
race a lot of them are low-income and lack the resources to thrive in society. Due to the urban
area that Karmanos is located in a lot of the patients are in fact of color. Most of the patients are
referred by a doctor to come to Karmanos to get a second opinion and then began the cancer
treatment if necessary.
Karmanos prides itself on building strong relationships with the community. Karmanos
works with the housing commission of Detroit to find housing for patients who have temporary
housing to get them permanent housing. Patients who do not have housing are unable to receive
treatment due to health risk that may arise. Karmanos also works with Detroit Cab to ensure that
patients that do not have transportation can receive rides to and from their appointments. Women
who have may have undergone a double mastectomy or feeling down about their hair loss due to
chemo and radiation, Karmanos partnered with several different wig banks in the metro-Detroit
area for women.
Theoretical Construction

According to Netting, Kettner, and McMurtry, and Thomas 2012 a bureaucracy is an

ideal type, which means that is a conceptual construct. An organization that is made up of a
bureaucracy are grouped into a clearly defined hierarchy (Netting, Kettner, McMurtry &
Thomas, 2012). Job selections in a bureaucracy are based on the applicants technical
qualifications (Netting, Kettner, McMurtry & Thomas, 2012). At Karmanos the staff follow a

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chain of command starting with the President Margaret Diamond at the top. The Staff are hired
based on their credentials and the hospital is split into different departments, each having a
different role.
Organizational goals and the natural system perspective as described by Netting,
Kettner, McMurtry, & Thomas 2012, is the idea that the organization forms a formal structure,
the original leaders move into positions at the upper level and they discover the personal
advantages of having these positions (Netting, Kettner, McMurtry & Thomas, 2012).
Organizational goals and the natural systems focus on the people to run the system (Netting,
Kettner, McMurtry & Thomas, 2012). That is how management runs in the hospital setting. The
decision making process is also made by the individuals who have power. They work together
and share an allegiance with one another, which produces conflicts among the staff that work on
the lower levels because they are ultimately the only ones affected by the decisions and
outcomes. Organizational culture which is defined as the way things are done or unwritten rules
of behavior in an organization. In the internal environment organizational culture is important to
the benefits of the staff and patients. The cultural model explains that multiple cultures can exist
within an agency (Netting, Kettner, McMurtry & Thomas, 2012).
These theories help outsiders to understand that way the organization functions and the
internal foundation of the hospital. These theories in part describe the exact way that the agency
is set up and I believe by choosing the theory of bureaucracy as the structure most agencies and
organizations are run on that theory which makes it easy for most to understand.

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Recommendations

I believe the biggest issue Karmanos faces is the way it is run. In my opinion you cant
run a hospital in such an urban area and not have the diversity that is crucial to the foundation of
running a cancer-based hospital smoothly. Diversity affects so many different aspects of an
organization and it is often the most important issue of concern. Most of the diversity begins on
the bottom level and the higher you climb the corporate ladder the more scarce faces like mine or
other faces of color are seen. Lacking diversity in an area where it is so crucial to identify with
the patient can only hurt the organization. Most patients are vulnerable when they enter the doors
of Karmanos. They dont know what their prognosis is and the fear of the unknown is hard, so
having someone who looks like you or shares a story similar to yours helps the process to
become a little easier. If I had to make a change it would start with diversifying every level of
corporate. I would bring in more faces of color that are equally qualified and promote strong
relationships with the executives and patients.
According to guidestar.org, Karmanos had an annual profit for the 2013 year of twenty
six million dollars and since then the profit has increased, but due to budget cuts the hospital had
to fire department supervisors and lay off nurses and techs (Guidestar.org, 2015). The revenue is
there but to make Karmanos better as a whole we must be willing to evaluate each persons role
to make sure that the patients are receiving the best care. Changing the faces in corporate
realistically may not happen due to tight bonds and partnerships, but holding cultural competence
training for the staff and workers to show them that they in fact need to be culturally aware
would force the staff to understand the reasons for diversity on every level.

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References
Binachon, B., Dossus, L., Danjou, A. M., N., Clavel-chapelon, F., & Fervers, B. (2014). Life in
Urban areas and breast cancer risk in the French E3N cohort. European Journal of
Epidemiology, 29(10), 743-51. doi:http://dx.doi.org/10.1007/s10654-014-9942Cancer.Org. (n.d.). Cancer facts spread sheet. Retrieved from http://www.cancer.org
Guide Star. (n.d.). None profit report for Barbara ann karmanos cancer institute. Retrieved from
http://www.guidestar.org/organizations/38-1613280/barbara-ann-karmanos-cancerinstitute.aspx
The karmanos advantage. (n.d.). Retrieved from http://www.karmanos.org/about/advantage
Netting, E., Kettner, P., McMurtry, S., & Thomas, L. (2012). Social
Work macro practice. (5th ed.). Saddle River, New Jersey : Pearson Publishing Company

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Swot Analysis
Agency: Karmanos Cancer Institute
Internal Environment Strengths:
-

Advantages of the organizations are the services offered

Patient advocates
The resources for the patient and families
Friendly staff

Internal Environment weaknesses:

-

Patient wait times

Communication between patients and doctors
Number of employees fired or laid off

External Environment Opportunities:

-

Partnerships with other hospitals i.e. Non-cancer related hospitals

Community awareness through ads and social media to understand the role of
Karmanos.

External Environment Threats:

-

Hiring outside executives to come in and make decisions.

Competing with area hospitals that are more skilled in the basics of patient care and
patient waiting times.