Running head: ORGANIZATIONAL ANALYSIS

Organizational Analysis of Critical Signals Technology

SW 4020
Crystal Manney
Wayne State University

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Abstract

This paper will examine the growing need for innovative healthcare services for the aging
population. As the Healthcare industry continues to evolve, there will be more dependence on
Home Health Care agencies to assist in maintaining the health of the aging population. This
paper will show the effectiveness of in-home personal emergency response system (PERS)
services. These services provide the ability for this group of people to age in place, this is defined
as keeping the older population in their homes rather than placing them in assisted living, nursing
homes, or living with family members.

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Organizational Analysis of Critical Signals Technology

There are many challenges that different groups of people must overcome. The aging
population is one group that struggles with a variety of different physical, mental, and emotional
problems. Historically, as generations have aged, they have been placed in nursing homes or
assisted living facilities by their families. According to the Centers for Disease and Prevention
(2013),
The growth in the number and proportion of older adults is unprecedented in the history
of the United States. Two factorslonger life spans and aging baby boomerswill
combine to double the population of Americans aged 65 years or older during the next 25
years to about 72 million (para. 3).
This will put stress on an already thin health care system. Critical Signals Technology (CST) has
designed tools and services which will allow these older adults to age in place, this means that
the older adult can remain in their home with independence. According to an AARP survey
(2010), nearly 90 percent of those over age 65 want to stay in their residence for as long as
possible, and 80 percent believe their current residence is where they will always live (p. 1).
Organization and Services
Critical Signals Technology is a for-profit organization that was created by Jeffrey S.
Prough. He had a dream in 2005 to help maintain freedom, independence, and assist the aging
population to age in place (J. Prough, Personal Communication, February 10, 2016). CST has an
FTE of 100 with an additional 400 subcontractors. CST is a Personal Emergency Response and
simplified cost effective Tele-Health solutions provider. They assist older adults and individuals
with mental or physical disabilities by providing low cost, technologically based options in

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todays increasing demands with healthcare reforms. (See attached Critical Signals Technology,
Company Overview, 2014).
CST has many different services they offer such as; Tele-Health, Medication
Management, Home Health Care Connect, Basic PERS (landline or cellular), and Basic
including Multi-Tenant. These services range from keeping track of blood pressure and weight of
the patient, to medication devices that dispense the patients medication for them, doing wellness
calls to follow up with patients after illness or hospitalization, assisting patients with resources
or counseling, to using this response system in nursing homes, rehabilitation centers, and hospice
centers.
CST has patients in all fifty states in the United States utilizing all of the above services.
This company has partnerships with hospitals, health plans, home health agencies, nursing
homes, hospice centers, and independent living facilities. CST assists in the transitioning of care
of patient, hospital re-admission management, cost-effective care for chronic illnesses, reducing
ER visits, improve patient experience, and improve data sharing patient information across the
healthcare ecosystem (see attached Critical Signals Technology, Company Overview, 2014).
My position with this company is in the Health Care Connect (HCC) department. Jeffrey
S. Prough, the CEO, of this company, has a great vision for the HCC department. He wants to be
set apart from other emergency response companies by having social workers on staff to help
address issues of depression, loneliness, thoughts of suicide, or any other issues that social
workers have been trained to deal with in this demographic.
I have a variety of different tasks that I do on a daily basis. One of the primary tasks that I
perform are wellness calls, these consist of 1-hour install, 5-day, and 15-day calls. Each call has a
different set of questions and information that I need to obtain from the patient to note in their

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account. I also work on research for resources that patients may request such as; Meals on
Wheels, transportation to doctor appointments, durable medical equipment that a patient may
need after being discharged from the hospital, or even finding a barber located in the city or state
a patient might live. Some patients will ask that I contact the agency in order to speak to a nurse,
request assistance in setting up appointments, or just need to speak to me concerning issues they
might be dealing with that are difficult. Many of the patients that I talk with are struggling with
health issues that are just part of aging, but can cause depression.
Mission and Goals
Jeffery S. Prough wrote the mission statement for CST one year before the company ever
came into existence. He was a success driven man who worked his way up through different
communications and alarm system companies. He was one of the first recipients of cellular
licensing. He saw an opportunity to change the face of alarm companies by adding medical
alarms to assist the older population. According to Piau, A., Campo, E., Rumeau, P., Vellas, B., &
Nourhashemi, F. the alarms are defined as follow, Alarms and personal emergency response
systems collect data to detect adverse events(p. 99). In order to fully understand the aging
issues, he started his own Home Health Agency by becoming licensed and worked with a variety
of medical professionals. He soon realized there was a gap in the care that was available to the
older adults, and started CST in June of 2006. The mission statement is as follows,
CST is a personal emergency response and monitoring service organization. Our goal is
to respond to the needs of todays demand for health care solutions, which will allow
individuals to live and rehabilitate in their own homes independently without
compromising their dignity. We do so by developing, supporting and implementing
innovative cost-effective products and services that we monitor enabling us to respond to

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the individual needs of each customer we serve (see attached Critical Signals Technology,
Company Overview, 2014).
The leadership of the company determines the goals; the Mr. Prough is very passionate about
ensuring patients get the best care plan solutions as possible. He is always evaluating programs
to see if anything needs to be changed or update in any way. The organizational influences that
are in place in this company are the dedicated and devoted team that the he handpicked when he
started the company. He has a wide array of trained staff in the business, medical, and the
technological areas. This team continues to develop new innovation and programs to better serve
the aging population.
Organizational Structure and Staffing
This organization consists of many different departments. The CEO/President Jeffrey S.
Prough has the highest position in leadership in the company; he over sees the entire company.
The CPO Jerry Johnson is in charge of the operation of the warehouse, billing, HR, and the
financial controller. Tom Reddy, the Executive VP, Operations, and IT, oversees the Care Center,
the IT department, and Data Analysts (attached Organizational Chart). There is defined
leadership on every level of the company. As an example, Mr. Prough had an idea to find
additional resources to pay for the cost of the device for patients so he went to Heather Sellar
who is the Executive Director and General Manager of Financial Accounts to discuss ideas in
which they could find external resources to pay for the patients device. Another example is the
structure within the HCC department. There are different levels that each HCC Care Center
Representative must test for skill and knowledge. There is the entry level, level 2, level 3, level 4
or lead position, Care Plan Solutions Manager, and finally the Care Center Director. The higher
the level, the more skill and knowledge are required for leading the team. According to a recent

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study on Telecare and aging in place, the authors Procter, R., Wherton, J., Greenhalgh, T.,
Sugarhood, P., Rouncefield, M. & Hinder, S. (2016) state, Its findings highlight the importance
of the interpersonal skills and social resources of staff to make technology work (pp. 21-22).
Each of these individual departments works together to provide the best service possible for the
patient.
There is a very diverse group of employees at this organization. In my agency there is no
evidence of any issues in regards to discrimination among the staff. It is, however, evident that
there is no diversity among the upper management, but this company does however have a policy
in place to offer job opportunities internally before seeking the external hiring of new employees.
The entire social work staff or HCC consists of only women at this time.
This company works in all fifty states and has a diverse group of patients utilizing
services provided by CST. This company even has employees who speak other languages such as
Spanish in order to communicate with Latino patients. In the past there have been other
employees who have spoken Arabic as well as other languages to assist patients. CST also
utilizes a program called The Language Interpretation Line that provides interpreters that can
interpret for the Care Center Representatives with patients that speak a different language to
better serve them.
CST works with the aging population and strives to continue to educate and inform the
staff about the different issues that this population deals with for example, the Care Center had
training on Older Adult Suicide in January to ensure that patients who are struggling can be
accessed and get the help they need to address personal issues. All the staff has had training in
their departments to be aware of and sensitive to the needs of the aging population.

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Internal and External Environment: Relationship with Community

When I started as an intern at this company, I had little knowledge about the
company as a whole. I asked my supervisor if I could set up some time to talk to different people
in the organization. One staff member I had the opportunity to speak with was Heather Sellar,
she is in charge of researching and finding different types of funding to pay for some of the
services the agency is providing for patients. During my interview Ms. Sellar stated that some of
the agencies advantages were the types of services that are offered to patients, as other
emergency response agencies do not have a social work aspect to them. Another strength this
agency has is the leadership and innovative minds that are on staff within the agency. Everyone
understands the expectations for their job position within the agency. While talking with the CEO
Jeffrey S. Prough, he shared that one of the things that this agency does well is help older adults
age in place. This service helps patients live in their own home longer. He also stated this agency
is unique as I stated above with social workers on staff to address mental and emotional issues
with older adults. Mr. Prough also shared that when he spoke with investors he wanted to be able
to observe and be a part of every aspect of the agency when it was created. The systems in place
and the structure of this company are also considered strengths for this agency; there are defined
expectations for each department. This is the reason there is only one CST located in Novi
Michigan.
While talking to the Mr. Prough, he stated that one of the weaknesses in this agency is
lack of communication. He shared sometimes it is very difficult to give new information to
agency staff because details can change and he does not want to get staff members hopes up or
frustrate them with constantly changing information. He stated he was not sure how to, but that it
needed to be addressed. While working within this agency I have seen this to be true, many times

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a Home Health Agency does not have clear instructions for the Care Center staff and patient
protocols and the information can change on a daily basis. This can be very frustrating for staff
members.
This agency has opportunities that non-profit agencies do not have because they have an
income. During my interview with Ms. Sellar she stated that this agency has unique opportunities
to help other agencies within the United States. This agency has created a partnership with the
National Area on Aging (N4A) called CareNet. The Area on Aging Agencies (AOA) only
receives a certain amount of federal funding. When this money is gone they cannot help the
aging population, but because of this partnership with CST, the AOA can now address other
financial needs of the older adult population through the income generated from CareNet.
Another opportunity for growth is the baby boomer generation. As the baby boomer
generation reaches older adulthood, they will more than likely remain in their homes longer. The
findings of a study conducted by Melander-Wikman, A., Fltholm, Y., & Gard, G. show, that
mobility which can be seen as prerequisite for participation in society, is a dimension of
empowerment (p. 343). The types of services offered by this agency will be in demand and
utilized more often as the older population has to start making medical stability decisions. This
shows there will be growth in the number of patients using the services and the increase in
income potential for this agency. Applying for new grants is also an opportunity for growth in the
company. According to Ms. Sellar, she has different sites that she uses that will alert her when
there are any new grants available to obtain. These are Goggle alerts, vendor websites and
finding RFP. Her staff is always filling out paperwork for potential grants. This agency has
obtained a block grant in California to pay for PERS services for CST customers. PERS is
defined as, Personal Emergency Response Systems.

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There are many potential obstacles for this agency; Ms. Stellar shared how difficult it is
to apply for grants. The process is very tedious and time consuming. There are very strict rules in
regards to every detail of the proposal. The proposal must be in the correct font, have page
numbers, be in the correct format, and be delivered on time just to be considered. There are four
steps that must be completed, the first is to be qualified is this agency a sound and stable
agency, the second step determines if the equipment qualifies, the third step asks if this agency in
compliance with regulation, and last step asks the question does the price for service compare to
the value? During my interview with Mr. Prough, the CEO, I asked him what he though were
threats to the company and he shared that his company is unique and he feels there are no
apparent threats to the agency.
CST obtains patients through partnerships with Hospitals, Home Health Care Agencies,
Nursing Homes, Physicians, and AOA. This company does not advertise for public use. It is
strategically placed within specific advertisement for large facilities or groups not for separate
individuals. This was done according to Mr. Prough to cut down on costs. He stated it would be
very hard to fight with one patient to get payment verse a larger entity. His desire is to help the
most people while being efficient. This agency, as stated above, works with larger groups such as
Hospitals and multi-tenant facilities.
Theoretical Construct of Organization
This organization has different aspects of multiply theories. The structures with policies
in place resemble a hierarchy and have some Bureaucracy theory. This agency is also customer
focused so it would also be considered Quality-oriented Management. According to Netting,
Kettner, McMurty, & Thomas (2012) a Bureaucracy is defined as,

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Bureaucracies emphasize efficiency of operation. Decision making is done at the top, and
authority to do so is based on expertise rather than inherited authority. Tasks are
specialized, organizational relationships are impersonal, and a by-the-book orientation
restricts individual discretion (p. 215).
Although this theory has its strengths, one of the weaknesses is missing out on creativity
or the input of others who may have great ideas for innovation. In the agency there is a strict set
of requirement for each position. I could not help out or work in the billing department because
they are specially trained for that position. The agency must follow certain protocols and the
chain of command, for example if someone needs help with something they would ask a lead
representative first in order to get a problem resolved. If the issues still do not get it resolved they
would continue to move up the ladder until the problem gets resolved correctly.
The other, this agency closely relates to the Scientific and Universalistic Management
theory. This agency is a for-profit company, because it produces revenue for the services
provided. It is very important the management team be aware of controlling cost and maximizing
efficiency when running this agency. I chose these theories because they best fit the description
of the format of this agency. Not all agencies are for-profit and have to be concerned with
specialized task oriented employees or the cost of manufacturing a product, in this case the
medical alarm devices. Netting et al., (2012) describes this as follows, to develop the best tools
for completing itthe next step is to provide incentives to increase productivity (p. 217). This
company depends on the revenue from the services provided, so it is important to keep the staff
engaged and productive to complete all necessary tasks for the day.

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Recommendation

As an intern at this agency, I have been able to see many different aspects in the HCC
department. One concern that I have is the amount of turnover that exists among the social
workers. As social workers, we should be able to address issues and try to figure out solutions. In
this agency I do not feel like I would have a voice in developing any resolution to this particular
issue. There is a lot of hierarchy in this agency as I stated above and it could potentially hinder
the abilities of the social workers. I feel there is a disconnect with in the Care Center, each part
has its role to play but I feel sometimes the different sides do not always play nicely together.
I can totally see the passion that Mr. Prough has to meet the needs of the older population; I just
do not see that same attitude reflected by others employed in the agency. This saddens me as I
can hear how different people interact with patients on the phone. I think we sometimes forget
we are affecting someones life. It might make a difference in how employees approach their
position within this agency if a patient was sitting in front of them rather then on a phone.
Regardless, it is our job to serve the oppressed and weak populations and stand up and advocate
for them.
One strength that I have observed is that this agency is that this agency is completely
confined to one location. Everyday Mr. Prough, the CEO, walks though each department or area
and personally greets every member of the staff. This creates a positive environment to work
within. The systems in place and the structure of this company are also considered strengths for
this agency; there are defined expectations for each department. He is one of the most interesting
people I have met; he has so much passion for this group of people.
Due to the structure of this organization it would be very hard to change the way things
are done. There are so many different external influences that control how certain procedures are

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performed. For example, each agency that works with CST has a different protocol or set of
questions they want to have the HCC center ask patients. Trying to remember each of the
agencies plans can be difficult. It would be easier if Mr. Prough developed one universal protocol
or set procedure for all agencies that work with CST. This would minimize the frustration among
the HCC team. The fact that this is a for-profit agency they allow for whatever the agency wants
to do with their plans.
This company does a reasonable job at showing they care by giving awards out, but I
believe they can do so much more on individual department levels. Just showing genuine
appreciation for jobs that have been completed and employees taking on special assignments. If
the supervisors set an example the crew would follow the lead.
Conclusion
This assignment has given me the opportunity to really understand the purpose and
direction behind the agency. To be able to sit down with the CEO and talk about how he started
out on this path and end up where he is today was priceless. He always referred to Ms. Jones; we
do this because of Ms. Jones. The decisions I make affect Ms. Jones. His passion has ignited a
fire in me to always remember who I am working for, with, and why I am advocating.
This agency is a wonderful resource for many families that are struggling with how to
allow their parents to live on their own. While the dynamics of our health care system are
evolving this population have options to be able to remain independent. They can now live
without fear that if something happens no one will be able to help them.
This agency continues to give back to the community as well by making partnerships that
can effect change in many different lives.

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References

Centers for Disease Control and Prevention. The State of aging and health in America 2013.
Atlanta, GA: Centers for Disease Control and Prevention, US Dept. of Health and Human
Services; 2013.
Farber, N., Shinkle, D., Lynott, J., Grage-Fox, W., & Harrell, R., (2011) Aging in place:
A state survey of livability policies and practices. Retrieved from AARP
http://assets.aarp.org/rgcenter/ppi/liv-com/aging-in-place-2011-full.pdf
Melander-Wikman, A., Fltholm, Y., & Gard, G. (2008). Safety vs. Privacy: Elderly persons'
experiences of a mobile safety alarm. Health & social care in the community, 16(4), 337346. doi:10.1111/j.1365-2524.2007.00743.x
Netting, F. E., Kettner P. M., McMurtry S. L., & Thomas, M. L. (2012). Social work macro
practice. Boston, MA: Pearson Education.
Piau, A., Campo, E., Rumeau, P., Vellas, B., & Nourhashemi, F. (2014). Aging society and
gerontechnology: A solution for an independent living?. Journal Of Nutrition, Health &
Aging, 18(1), 97-112. doi:10.1007/s12603-013-0356-5
Procter, R., Wherton, J., Greenhalgh, T., Sugarhood, P., Rouncefield, M., & Hinder, S. (2016).
Telecare call centre work and ageing in place. Computer supported cooperative work
(CSCW), doi:10.1007/s10606-015-9242-5