BUS735FP

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RESEARCH PAPER ASSIGNMENT 1 Research Paper Assignment Faizan Malik Liberty University June 26, 2022

RESEARCH PAPER ASSIGNMENT 2 Abstract Credible Behavioral Health, Inc. (CBH) is one of the largest behavioral health electronic health record (EHR) software companies in the United States. Offering a plethora of features such as a mobile application, inpatient and residential modules, and electronic prescribing, CBH’s software is used by medical professionals offering behavioral health treatment in hospitals, clinics, and social services non-profits. Recently acquired by Qualifacts, a competitor within the behavioral health EHR market, CBH continues to undergo continual change and faces several challenges within the organization. Despite being an industry leader, CBH's constant employee turnover as the merger with Qualifacts remains ongoing. With the departure of several long-tenured resources over the past year, CBH is facing a dearth of knowledge of their software amongst the current staff, which becomes evident with software development and support. CBH also faces difficulty with implementation and adherence to process management as related to the recent merger. With Qualifacts policies now governing both organizations, the executive team is facing challenges when attempting to implement those procedures on the CBH side. As a result, there is constant miscommunication and misinformation amongst the CBH staff in terms of current policies. Finally, CBH faces challenges related to the usability of its software. Directly correlated to employee turnover and unclear organizational policies, the overall quality of CBH’s software has diminished since the merger due to a large of defects introduced into the software resulting in dissatisfied customers. If the aforementioned challenges are not addressed, CBH and Qualifacts face a failed merger and a potential loss of position within the behavioral health EHR market.

RESEARCH PAPER ASSIGNMENT 3 Introduction Founded in 2000, Credible Behavioral Health, Inc. (CBH) quickly became the leader in the behavioral health electronic health record (EHR) industry. By offering new and innovative features targeted specifically for medical professionals, CBH’s software is well respected within the behavioral market, earning the #1 ranking in behavioral health EHRs for 2021 by KLAS Research, the leading healthcare IT research firm that provides rankings of vendors within the industry. Despite their success, CBH has faced many challenges affecting both internal and external stakeholders. Combined with a saturated EHR market, CBH was acquired by Qualifacts, a former competitor, in 2020. Even with the merger, CBH continues to face many of the same issues and have even encountered newly introduced challenges since the merger. These challenges have included consistent employee turnover, difficulties implementing organizational policies across the merged organization, and diminishing quality and usability of their software. This paper will provide an in-depth review of these challenges, identity key chrematistics of the organization, and apply several theories to the organization. The paper will then provide a personal and Biblical perspective on the organization and its challenges. Challenges Employee Turnover Since it’s inception, CBH has been plagued with an alarmingly high employee turnover rate throughout and has struggled with employee retention. At it’s worst, it is estimated that CBH faced an employee turnover rate of greater than 20%. With such a high level of employee turnover, CBH often struggles with maintaining consistent levels of knowledge of internal knowledge of their software. Depending on the department, this can result in a multitude of issues for both CBH’s software and the support they offer their customers. These include delayed

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RESEARCH PAPER ASSIGNMENT 4 software development, defects being released into their software, and inadequate support. Not only does the high level of employee turnover affect CBH’s software, but it also has had detrimental results on the organization. O'Connell and Kung state employee turnover can result in lower organizational morale, decreased productivity, high costs incurred by the organization with the cost of replacing a salaried employee being six to nine percent of their salary (O'Connell & Kung, 2017). The high employee turnover rate can be attributed to multiple factors such as the competitive EHR market and fast-paced industry, with top talent often being recruited by larger organizations. However, single most contributing factor to the high turnover rate at CBH is the toxic work environment created by the management team prior to the merger with Qualifacts. Chamberlin and Hodson cite that organizations with high levels of interpersonal conflict, a lack of worker autonomy, and a high level of disorganization result in issues for both the organization and its members. The organizational culture under previous management leaned on fear tactics, oftentimes terminating employees for the smallest of errors and reprimanding those who were not seen as fit for the organization. Not only were employees terminated on a regular basis, but many would also leave voluntarily with concerns of job security. Although there has been a change in management since the merger, the organization continues to face issues with high employee turnover rates. Organizational Policies Although the merger with Qualifacts has provided CBH with numerous benefits, the larger organization continues face challenges when attempting to implement organizational policies. Despite operating in the same domain, CBH and Qualifacts daily operations were unique to each organization. From the life cycle of their software development to the organization of their support teams, each entity operated independently during the first year of

RESEARCH PAPER ASSIGNMENT 5 the merger with little to no interaction between the two organizations. However, over the past year, the merging process has been underway and has subsequently introduced new challenges to the organization, specifically for those operating under the CBH platform. With Qualifacts being the parent company, a majority of their policies were implemented to the larger organization. Many of the shared leadership positions were given to those originally from Qualifacts, causing a mass exodus of CBH managers. Changes in policies governing software development caused monthly delays in the release of new code. Employees were given reduced benefits and more expensive healthcare insurance. The newly implemented policies caused consistent confusion and frustration amongst CBH team members. While many in management focused on the technical aspects of the merger, many failed to acknowledge the human side and failed to emphasize guiding and supporting their employees during the change (Grigoris, 2018). As a result, CBH employees often face consistent confusion and misinformation regarding organizational policies, only furthering the existing frustration that many experience. Combined with the high turnover rate, and despite their continued success within the market, CBH has become considerably weaker since the merger and continues to rely on outside vendors to assist with daily operations. Software Usability Issues As a result of the constant employee turnover, dearth of institutional knowledge, and confusion regarding organizational policies, the overall usability and quality of CBH’s software has diminished. Since the merger, the number of defects released into their software has remained significantly higher than previous years, causing frustration amongst customers. Software that fails to meet the customer’s needs in terms of quality often causes the organization to incur additional expenses in repair, maintenance, and future business opportunities (Mockus &

RESEARCH PAPER ASSIGNMENT 6 Li, 2005).Given their technical team has remained critically understaffed, CBH has used outside vendors for software development and testing, often at a significantly reduced cost when compared to traditional full-time employees. However, with reduced cost has come reduced quality as well. Not only are a large number of defects being released into CBH’s software, but the number of innovative features being also added has been significantly decreased as well. With innovation being a hallmark of the organization and customers needing specific features to adhere to various regulations, the decreased number of features being added to the software has only further customer frustrations. As a result of these customer frustrations, CBH has faced increased churn rate since the merger, losing several long-tenured customers. Despite the continual customer frustration and loss, CBH has maintained their position in the market. However, it is to be seen if this is sustainable. Organization When analyzing CBH prior to the merger, the company most closely aligns with a rational organizational system. The organization operated under a certain degree of formalization, with many policies being firm and long-standing, however enforcement of policies varied throughout the organization. However, despite the degree of formalization that existed within CBH, management often failed to define common goals with specific limits (Scott & Davis, 2015), with employees often unaware of the expectations from management. Poorly defined goals do not provide the necessary context to develop a workable plan for organizational members. Furthermore, with all aspects of the organization being calculated to have an intended purpose, individualism was not encouraged throughout the organization and limitations on what individual contributors could accomplish were created (Scott & Davis, 2015). CBH also most closely aligns with a stable network structure, relying on various forms of outsourcing to

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RESEARCH PAPER ASSIGNMENT 7 increase their flexibility in the value chain. With their reliance on outside vendors for a majority of their software development and testing, CBH has formed long-lasting relationship with many vendors to compensate the lack of full-time employees. In relation to their technology structure, with CBH most closely aligning with a rational organizational structure, the organization has specific personal assign to tasks based on their possessed skills to achieve organizational goals. However, in terms of social boundaries, CBH continually fails to have employees understand established polices, even post-merger, with many policies failing to follow a top-down model from Qualifacts to CBH employees (Scott & Davis, 2015). Applied Theories In further analysis of CBH and the discussed challenges, there are a multitude of theories that can be applied to organization’s current practices as well as suggested theories that can be applied for improvement within the company. Beginning with the high levels of employee turnover, management at CBH often employed tenants of the Vroom’s expectancy theory when attempting to increase employee retention. This theory is dependent on three factors: expectancy (what employees expect for their efforts), instrumentality (employee performance being adequate to achieve a desired outcome), and valence (fulfilling basic needs) (Lee, 2007). By offering higher than market salaries and lucrative benefits packages, CBH’s management incorrectly assumed they could increase employee retention. Management should have rather employed the management by objective theory, which exists on the premise that employees are more likely to be motivated by goals and objectives they were involved with setting (Rogers & Hunter, 1991). By offering employee a mean to have input variables that affect employee’s daily operations and other avenues for strategic inputs, the organization is more likely to retain the most innovative and internally driven employees.

RESEARCH PAPER ASSIGNMENT 8 In terms of the issues implementing organizational policies since the merger, CBH (and Qualifacts) has attempted and failed to utilize the equity theory of motivation. This theory is based on the concept that people are motivated rather than external or internal factors, such as money or a desire to be promoted (Pritchard, 1969). By implementing Qualifacts policies over CBH, management thought they were setting a precedence of fairness amongst employees. However, this resulted in decreased benefits for CBH employees, confusion regarding holidays, and other issues amongst the CBH staff members. Management was better suited to adhere to the contingency management theory, which is based on the concept that there is single best way to operate an organization but rather is dependent on internal and external situations (Luthans & Stewart, 1977). Rather than blindly implementing policies across the organization, management needed to consider the needs of CBH employees and based their policies on the collective organization. By doing so, management could have eliminated the confusion that only further frustrated CBH employees. A study performed by Noll et al. illustrated that, for software development, suggest that organization follow Deci & Ryan’s self-determination theory where the three aspects that best motivate employees include autonomy, competence, and relatedness (Noll et al., 2017). CBH has traditionally followed a waterfall methodology for their software development, which uses a linear approach where all requirements are established during planning. However, if the organization were to follow agile methodology, where contributors are free to discuss and change requirements as development takes place, they would increase the overall autonomy for software developers and subsequently increase the quality of their product. Moe et al. suggests that for an agile team to be fully autonomous, leadership should be diffused rather than centralized, with duties transferred to a person with key knowledge and skills to perform the

RESEARCH PAPER ASSIGNMENT 9 required tasks. “While the manager maintains leadership for project management duties, the team members lead and are responsible for decisions when they possess the knowledge that needs to be shared during different phases of the project” (Moe et al., 2021, p.4). Personal and Biblical Perspectives Despite their numerous shortcomings, the individual employees of CBH have been the driving force behind the organization’s success. Those who have a passion for behavioral health and/or software development have allowed the organization to stay afloat in light of the challenges faced by the company. If the organization emphasized the needs of their employees over the wants of management, it is possible the company would not have been acquired by Qualifacts, which was in a lower market position during the time of acquisition. As the merger continues, current management is attempting to mitigate some of the challenges incurred by the previous regime. However, in doing so, they have introduced new challenges that are primarily affecting CBH employees. Failure to address these new challenges will only sever to further alienated the two entities and could potentially lead to a failed merger. Proverbs 29:2 states, “When the righteous increase, the people rejoice, but when the wicked rule, the people groan.” In this verse, it is believed that when righteous is present within a society, the members will rejoice. However, when those who only concerned with self- fulfillment are placed in positions of leadership, the members will groan. Organizations depend on leadership to achieve their mission, setting goals and helping individual contributors reach their full potential. CBH lacked positive leadership and, as a result, the organizational members suffered. Be it from the affects of high turnover or issues with the software, righteous leadership was not in place to correct these issues. When the Lord is not in our lives and we lack righteous around us, we suffer as individuals.

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RESEARCH PAPER ASSIGNMENT 10 Conclusion Despite their success, CBH has been plagued with internal issues that has ultimately begin to affect their customers and puts their position in the market at risk. High employee turnover rate, failure to implement polices across the merged organizations, and decreasing quality of their software are just some of the challenges faced by the organization. Although the organization operates most closely as a rational organization in a stable network, failure to adhere to all the tenants of these methodologies only severs to worsen the issues faced by the organization and its employees. If the organization continues to hemorrhage resources on a regular basis and rely largely on By implementing several new motivational theories, such as the management by objective theory, contingency management theory, and Deci & Ryan’s self-determination theory, the organization is better suited to face their challenges and can return to being a top choice in the behavioral health EHR market.

RESEARCH PAPER ASSIGNMENT 11 References Chamberlain, L. J., & Hodson, R. (2010). Toxic work environments: What helps and what hurts. Sociological Perspectives , 53(4), 455-477. Grigorios, K. (2018). The impact of mergers and acquisitions on corporate culture and employees: The case of Aegean & Olympic Air. Academy of Strategic Management Journal , 17(1). Lee, S. (2007). Vroom's expectancy theory and the public library customer motivation model. Library Review . Luthans, F., & Stewart, T. I. (1977). A general contingency theory of management. Academy of management Review , 2(2), 181-195. Merida, T. (2015). Christ-Centered Exposition: Exalting Jesus in 1 & 2 Kings. Nashville, TN. B&H Publishing Group. Mockus, A., Zhang, P., & Li, P. L. (2005, May). Predictors of customer perceived software quality. In Proceedings. 27th International Conference on Software Engineering , 2005. ICSE 2005. (pp. 225-233). IEEE. Moe, N. B., Šmite, D., Paasivaara, M., & Lassenius, C. (2021). Finding the sweet spot for organizational control and team autonomy in large-scale agile software development. Empirical Software Engineering , 26(5), 1-41. Noll, J., Beecham, S., Razzak, A., Richardson, B., Barcomb, A., & Richardson, I. (2017, February). Motivation and autonomy in global software development. In International

RESEARCH PAPER ASSIGNMENT 12 Workshop on Global Sourcing of Information Technology and Business Processes (pp. 19-38). Springer, Cham. O'Connell, M., & Kung, M. C. (2007). The Cost of Employee Turnover. Industrial Management , 49(1). Pritchard, R. D. (1969). Equity theory: A review and critique. Organizational behavior and human performance , 4(2), 176-211. Rodgers, R., & Hunter, J. E. (1991). Impact of management by objectives on organizational productivity. Journal of Applied Psychology , 76(2), 322. Scott, W. R., & Davis, G. F. (2015). Organizations and Organizing. Routledge.

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