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The Teaching Hospital

Background

A teaching hospital with over 1,000 beds has been divided into two major sections; hospital facilities which provides general hospital medical care for patients, and a medical school which primarily provides education and research.  Although both sections are controlled by a Provost, both the clinical and medical divisions of the organization are divided financially, administratively, and physically being on separate sides of the hospital (Newstorm & Davis, 2006).

Because the school side of the hospital mainly deals with research, they receive large numbers of grants, which are not shared with the hospital side of the organization; mainly being used for new equipment, supplementing salaries, travel, and additional staff.  The hospital side however, is completely relied on State funding where they are required to allocated and account for every dollar (Newstorm & Davis, 2006).

Although the school and hospital are separate, medical school faculty are being integrated into hospital functions.  This makes the inconstancies of the two departments more visible by hospital staff and caused a clash of personality where school faculty were viewed as conceded, and hospital staff were viewed as incompetent (Newstorm & Davis, 2006).

In one case, faculty doctor Dr. Uric was particular liked my hospital staff, despite being perceived as a nuisance by faculty staff, since he shared grant money and was personally involved with his patients and staff (Newstorm & Davis, 2006). After selling a medical discovery to a private company which the hospital wanted nothing to do with, the hospital filed a lawsuit against the doctor after the product made millions(Newstorm & Davis, 2006).

To keep the suit and the doctor out of public eye in the hospital, the executive committee decided to move Dr. Uric out of the medical side of the hospital and promote him into a new position where he would focus more on medical researcher, keeping him isolated from the rest of the staff.  Put into the vacant position was Dr. Conrad who was more of a hardliner, less flexible, and keep himself distant from the patience and staff which the department was not accustom to (Newstorm & Davis, 2006).

Because of Dr. Conrad’s style of management the department began seeing turnover of staff, lost of moral, and patients who would rather die at home then stay in the hospital (Newstorm & Davis, 2006).

After news broke out of the situation in the department, the Dean and executive committee reinstated Dr. Uric into his former position, and began analyzing the situation; trying to play catch-up to the negative reputation the hospital had generated (Newstorm & Davis, 2006).

Summary of Recommendations

After reviewing the case, the following recommendations should be implemented:

  • Physical and administrative integration of the school and hospital, based on functional needs, to maximize space, and use of equipment and staff.
  • Design job description to include management traits which compliment the position.
  • Develop regular job and peer evaluations which help correlate personal traits to potential job openings.
  • Develop a Quality Assurance or Audit Department to recognize and prevent negative trends such as turnover rates in the early stages of development.

Analysis

The hospital suffers from several major problems, however not uncommon in a medical organization or hospital environment. All of the issues that the hospital faces can be grouped into four main issues:

  • Distribution of wealth
  • Physically and communication barriers
  • Regular peer and performance evaluations
  • Preventive statistical analysis.

In a high pressure job such as hospital work, management style plays an important role in how the staff function as an organization.  If we examine McGregor’s Theory X, which states that every person is lazy and needs to be motivated and controlled, and Theory Y which believes people want to work, and are self-motivated (Dessler, 2002), we can see that in general the faculty staff fall under Theory X. Because they labeled the hospital staff as civil service and time serving incompetent (Newstorm & Davis, 2006), they would consider the staff to be lazy and unintelligent.

When examining both Dr. Uric, and Dr. Conrad’s style of management, there is no clear clue as to how they fell under McGregor’s theories since the main issue was interpersonal skills.  The University of Michigan studies of leadership styles might better describe their management techniques.  Dr. Uric would be described as Employee-orientated leader, focusing on the needs of the patients and employees, while working on interpersonal skills.  Dr. Conrad on the other hand, would be considered a Job-Centered leader, focused on the technical and production aspect of the job (Dessler, 2002).

The communication barriers that the hospital faces are not uncommon in any organization.  Although department budgeting, and legal issues would be reported to the executive committee, internal problems, staffing issues and daily operations would not pass the level of department heads.  Although things such as additional training and hiring costs would appear to upper management, the transparency of the issue would be hidden in figures.  This would cause any major problems to remain in the dark until it becomes a critical issue before the executive committee would know about any problem.

Many of the staffing issues stem from the distribution of wealth with the school side of the hospital receiving far more money than required.  Not only is staff being better paid, but they are receiving perk benefits such as additional staff, better equipment, travel expenditures, and staff functions such as parties.  Although equalizing the funding will not fix all issues among staff, it will help remove the appearance of a two-tier system.

Recommendations

One of the key steps to making a more effective operating hospital is to physically integrate the hospital and school so that they are in cooperation with each other.  By grouping functions such as Renal Medicine, both clinical and research, several things are accomplish.  Staff specialized in any particular field of medicine are working closer together, promoting shared knowledge with theoretical and practical applications.  Additional funding from research that go towards new equipment and extra staffing can be utilized by clinical needs, maximizing output, and relieving financial needs by the hospital.

  It also maximizes hospital space used, allowing for the potential of leasing space out to private medical companies, adding additional revenue to the hospital.  Such activity would take several years to completely, and would have a high cost on the short-term budgeting, however would yield long-term savings over many years.  Each department would need to be analyzed individually since not all hospital functions would be financially viable to restructure.

Such things as job descriptions and redesign are not only inexpensive and relatively quick to develop, typically within a year, but the benefits appear almost instantaneously.  An effective way to analyzing management jobs is critical-incident job analysis.  In this analysis, critical behaviors of the employee are listed, which are important to making the candidate successful in the job.

With the behaviors in place, tasks that are associated with each are listed, and then prioritized in order of importance (Knomo, Fottler,& McAfee, 2005).  This process is important by allow the company to evaluate employees on their work performances, based on the critical behaviors that are important to each job.  Doctors with particular traits would lead more towards an administrative position, while others would lead to practical positions.

Finally, a Quality Assurance or Audit Department needs to be developed which would be a subcommittee to the Executive Committee, however providing reports for all levels of the organization. The purpose of the department is to develop and review statistics such as patient costs, staffing costs, quality of service, and work procedures.  This would allow upper management to identify trends occurring in the hospital at early stages.

Such things as abnormally high staff turnover is identified, and root cause analysis can determine problems and solutions to department operations.  Such a department would take one to two years to develop, and twice as long to become fully effective.  The largest advantage is that there are quantifiable financial results that can be shown in the benefits.  It would be beneficial for such a department to exist prior to committing to any movement of the departments.

Bibliography

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Dessler, G. (2002).  Management.  New Jersey: Pearson Education.

Knomo, S., Fottler M., & McAfee, R.B. (2005). Applications in Human Resource Management.  Ohio: Thomson, South-Western.

Newstorm, J.W., & Davis, K. (2006). Organizational Behavior 12th Edition. New York: Irwin Publishing

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