Describing Past Work Experience

Explain a time when you implemented organizational change while working or volunteering: Describe a time when you worked or volunteered and were in charge of bringing about an organizational change. In your response, please describe the change's nature and your involvement in carrying it out. What kinds of opposition to the change did you run into or notice? What steps did you take to influence people to change their routine behaviors and activities? What outcomes did your efforts produce?

When CMS changed the way nursing homes were inspected, I was a federal surveyor working for the agency. The format of the inspections was being changed from paper to an electronic process. While the regulations remained the same, the process itself was being radically altered. I encountered and observed many obstacles to the process, including challenges with old and insufficient IT equipment, bugs in computer software, lack of IT support, different computer literacy among team members, and resistance to a new system that many viewed as inferior to the existing process.

After months of organization-wide struggles with the process, I was chosen to be a member of a small team of existing surveyors who would receive advanced training with the new format, learning more about the technical side of the process. Upon completion, I immediately began training my fellow team members, adopting a positive approach and getting their buy-in to a still difficult process with the same inherent challenges with IT equipment not designed for the process. Ultimately, I successfully trained eight federal surveyors in the new process, helping to move forward the agency’s goal of expanding the implementation of the electronic survey.

2. Describe a work/volunteer situation in which you identified, developed, and implemented a technological solution to improve a system or process. What led you to believe that there was an opportunity for improvement? If there were multiple potential solutions, describe the costs, benefits, risks, and chances for success of each.

In my prior position as a federal surveyor, I worked on a team with over ten colleagues, combining to complete 75 required travel assignments across the region each year, with some individuals taking as many as seventeen trips. Organizing the data, and developing a travel plan to meet the division had become a challenging task. Ensuring the necessary work would be done while equitably coordinating everyone's schedules was proving even more difficult. My supervisor asked me to help improve the process.

The first step I took was to survey my colleagues and gather information on what types of ideas had worked well in the past, and what hadn’t worked as well. Through several spreadsheets and a defined plan, I developed a model to most efficiently address our division’s needs, and provide an equitable workload for all team members. The costs and risks were small, as there hadn’t been a system developed to that point, and so the chance of success was at least as good as before. But the idea was to improve employee morale, division efficiency, and productivity. And, the project was a success on all accounts. We met our goals, and most reported they appreciated the better distribution of work. Others also found things more manageable and better able to plan their schedules by having a more established work travel model. Due to its success, I was asked to continue the system I’d developed in subsequent years.

3. Describe a work situation when an internal or external customer was dissatisfied with the quality, quantity, timeliness, or manner of the service that you or your organization delivered. What steps did you take to remedy the situation? What was the outcome? In hindsight, how might you have prevented the problem from happening again?

One of my roles within HRSA is being an advisor to our NURSE Corps and NHSC scholars. I ensure scholars have a smooth transition from school to employment at an appropriate service site. Recently, one of my scholars, through no fault of his own, and as a result of incorrect data in one of HRSA’s databases, accepted a job at a hospital which he thought was a suitable site. After he had already moved and began work, I was alerted to the fact that the site should have been coded as not appropriate. The initial response from HRSA was that this individual would not be credited for working at that site, and he would need to find a different position. While respecting our regulations/policies, I also always try to balance them with a reasoned person approach, and this situation did not seem fair to me. I didn’t think it was right to adequately punish someone for a mistake we had made. I admire and appreciate the dedicated, hard work of our clinicians in underserved communities, and we support

I immediately met with my supervisor and crafted a memo describing the situation, and hinting that I thought it would be best in this isolated occurrence to relax the policy. After receiving feedback that a change in policy was not likely and while keeping my supervisor aware, I contacted additional staff in the corresponding division, becoming more vocal about my feelings that relaxing the policy for this situation was the right thing to do. After some persistence, and admittedly to my surprise, I eventually found the ear of someone in the right position who agreed with me, and with the ability to make my suggestion happen. The clinician was allowed to continue his service in a place that, although not technically an eligible HRSA scholar service site, nonetheless a clinic and patient population in need of his help.

To help prevent this from happening again, I met with my colleagues to make them aware of what happened. While we, unfortunately, were not able to control the input of bad data, I recommended that everyone check the integrity of the data in our system for every scholar to ensure a similar mishap wouldn’t re-occur. It has been effective, so far we had already caught a few errors and corrected them before any notable problems arose.

4. In describing a difficult work-related decision that you had to make, please answer the following questions: What information did you use? From whom did you seek input? What was the timeframe during which you had to make your decision? Who did your decision affect? How/when did you inform stakeholders of your decision? How did you justify your decision to those affected by it?

Part of my role with HRSA involves certifying/recertifying individual sites where clinicians are receiving loan repayment funding. These sites sometimes include solo practice sites, where the clinician is the owner, and also the direct recipient of our funding. While cases of fraud rarely come to our attention, and our operating procedures don’t particularly focus on discovering fraudulent activity, I came across a situation that I believed was suspicious. After gathering information from several sources including a visit to the site, online data and internal HRSA data available to me, it became more and more clear that inappropriate activity was occurring. During my investigation and reviews, I first discussed the situation with a colleague, and then alerted my supervisor. With my supervisor’s support, I was in touch with my division Director and Deputy Director, and from there an additional division within HRSA. Throughout the six month process, I was involved in meetings, memos, and phone calls. Ultimately it was up to me to push the issue forward and gather substantial evidence to lead to an ultimate significant penalty to the clinician.

While to some extent this was a fairly straightforward decision to make, there were a few times when I questioned my insistence on the pursuit. I found out early on that the clinician had recently had a baby, and also heard some anecdotal evidence of how her care had helped some individuals. And the penalty she received was moderately severe, and probably caused some significant financial issues for her recently expanded family. However, in other ways the justification was easy. After several years of visiting similar type of clinics, and seeing how much a majority of clinicians sacrificed of themselves to provide care to the underserved in our country, it made me mad to see someone blatantly taking advantage of the system, and effectively taking away, from a finite supply of funds, intended for good people doing the right thing. It wasn’t an easy decision knowing I was the one responsible for affecting this person’s life, but I felt proud knowing that because of my actions, someone, or several others would be able to be supported by HRSA in achieving the mission.

5. Describe a work/volunteer situation in which you had to gain the support of others in order to for a project you were responsible for to succeed. What strategies and tactics did you use to influence them? How did you address their wants, needs, and concerns? How did you use your understanding of organizational politics to achieve your objectives?

A few years ago, I made up my mind I wanted to get back into the clinical arena, as a physical therapist treating patients. To my surprise, I found out from a colleague that under the right circumstances and in my position at HRSA, I could potentially commit to 1-2 days per month at a nearby VA (Veterans) hospital. I was prepared to make a strong case to my division of how it would be mutually beneficial for me to allow for some clinic time in my position. Much of my work revolves around clinicians and healthcare settings, and returning to hands-on experience in the field seemed like a win-win, not to mention the benefit of helping the overworked VA system. I wrote a letter to my supervisor outlining my reasoning, expecting to receive some pushback from the division but was soon surprised and excited to find their immediate support.

Ironically, while influencing my workplace was relatively easy, I ran into obstacles at the VA. When I approached the hospital in my area, offering to volunteer my services as a licensed clinician on a set monthly schedule, they were skeptical. I explained to the rehab director the enjoyment I get from being in a PT clinic, and particularly in serving the veterans, and that I didn’t need the clinic hours for any license or career-related purpose. The director could not understand why I would do something without any perceived immediate benefit to me and questioned ulterior motives. She went on to say that the bureaucratic setup of the VA would make it more burdensome to her than a couple of days per month of free clinical help was worth. While she did offer to potentially setup a meeting to discuss further, it was obvious she was already using organizational politics as a barrier and seeing only the short-term pain vs. the long-term benefit. Rather than pursue a meeting with her, I decided to look elsewhere, to find a clinic wanting to fight with me despite organizational politics instead of using them as an excuse to poor outcomes. I knew to keep looking beyond one person’s disinterest.

Ultimately I found a different VA system, and after explaining to them my interest, and why I wanted to help in their clinic, they were more than happy to have me on board. Two years later, it continues to be a win-win situation for all, and I’m glad they were able to look to the future, and past the barriers, to see the rewards.