18.3)Gateway Hospital is a 500-bed tertiary-care hospital located in a busy metropolitan area. Arecent employee satisfaction survey scored well below the national norms on most scales.

The hos-pital has been facing higher than average turnover and vacancy rates. Recruitment of profes-sional positions is very difficult because the hospital has gained a reputation as a bad place towork, especially if one is new; the term "eat their young" seems to be a prevalent description.Salaries are below the local market, as are annual pay increases. In many departments thereseems to be a critical shortage of staff, and closing services has been a recent topic of discussion.

Additionally, the financial picture of the organization is bleak. The payor mix has changed;Medicare cutbacks are impacting the bottom line, as are changes in private insurance funding.Key physicians are beginning to take their services elsewhere, as they sense the inefficiency of thehospital processes.

The various stresses appear to be having a significant impact on the overall morale of employ-ees. Poor teamwork is rampant, and communication breakdowns seem to be a normal occurrence.Several leaders have been let go in an effort to address issues.The leadership of Gateway Hospital is extremely concerned about the organizational prognosisand has decided to begin to address the issues by enlisting the assistance of a consulting team.

One member of the team is a financial expert who has been hired to address the significant finan-cial issues affecting the hospital. The time frame on fixing the financial issues is one of a criticalneed; since the environment is rapidly changing, the consultant must get a handle on how to helpthe hospital operate successfully, given the current financial downslide.

A second member of the team is hired to address the morale and employee issues. A review ofthe employee opinion survey is conducted, and trends are identified in exit interviews. Employeeinterviews and focus groups are held in an attempt to determine the root cause of the moraleissues, as well as the breakdown in teamwork and communication.

The data collection is discussed with leadership; after a series of discussions, leadership admitsthat many of the financial pressures have created a "knee jerk" reaction to staffing issues, oftencutting back dramatically on employee hours. This would create a crisis mode and the need to askemployees to work harder.

This cycle has created a significant lack of trust from the employee'sperspective, coupled with the fact that employees have not felt that they have been apprised of thereasons for the roller coaster changes and have not been offered any words of appreciation whenthey have either reduced their hours or worked in a crisis.The consultant and the leadership agree that in order to fix the "people" issues of the organiza-tion, there will need to be a culture shift of leadership and employee interactions so that a trustcan be rebuilt.

Questions

1. On the basis of these issues, what OD interventions do you think should be utilized to addressthe problems this hospital is facing?

2. How would you proceed if you were the consultant in this case?

3. What skill set do you think the practitioner will need in order to be effective in this orga-nization?4. What type of a time line would you establish if you were this consultant?City HospitalCity Hospital is a growing hospital in a large metropolitan city.

The hospital is currently expe-riencing issues that many other organizations are also facing, that of the multigenerational work-force. The senior leadership of this hospital is the typical "baby boom" generation, but thepopulation of employees is slowly growing into one of a younger workforce.

The leadership isstruggling to deal with issues such as iPods at work, cell phone use, Internet use, tattoos, bodypiercing, and so on. Equally troublesome is a different perceived commitment to the job andbreakdowns in communication. Leadership has decided to hire an outside consultant to help theorganization understand the impact of the multigenerational workforce and to try to help becomea more cohesive organization.

1. Which type of OD intervention is the leadership using in this situation?

2. What obstacles do you see in this situation that may make this intervention more difficultthan other types?

3. What recommendations do you have for this situation?

4. What other interpersonal issues exist in organizations besides generational that may create aneed for an OD intervention?Case Stud

14.7)For each of the five scenarios described below, determine what is the most appropriate conflict-handling style(s).

Scenario One

A radiologist on the staff of a large community hospital was stopped after a staff meeting by acolleague in internal medicine. On Monday of the previous week, the internist referred an elderlyman with chronic, productive cough for chest X-ray, with a clinical diagnosis of bronchitis.

Thurs-day morning the internist received the radiologist's written X-ray report with a diagnosis of "prob-able bronchogenic carcinoma." The internist expressed his dismay that the radiologist had notcalled him much earlier with a verbal report. Visibly upset, the internist raised his voice, but didnot use abusive language.How should the radiologist handle this conflict with the internist?

Scenario Two

The Family and Community Medicine Division of a large-staff model HMO serves a populationthat is ethnically diverse. The senior management team of the HMO, spurred by repeated com-plaints from representatives of one racial group, has encouraged the division, all of whose physi-cians are white, to diversify.

Several black and Hispanic physicians with strong credentials applyfor the open positions, but none is hired. Weeks later, a young female family physician learns fromseveral colleagues that the division director has identified her as racist and the obstructionist torecruiting.

The comments attributed to her are not only false but are also typical of discrimina-tory statements that she has heard the division chief utter. The rumors about her "behavior" havecirculated widely in the division.How should the young female family physician handle this conflict with the division chief?

Scenario Three

A manager who reports to the Vice President for Clinical Affairs (VPCA) of a tertiary-care hos-pital hired a young woman to supervise development of a large community outreach program.

During the first four months of her employment, several behavioral problems came to the VPCA'sattention: (1) complaints from community physicians that the coordinator criticizes other physi-cians in public; (2) concerns from two community leaders that the coordinator is not truthful; and(3) written reports about the project that label and blame others, sometimes in language that isdisrespectful.

The VPCA spoke several times to the manager about these problems. The managerreported other dissatisfactions with the coordinator's performance, but he showed no sign of deal-ing with the behavior. Two more complaints come in, one from an influential community leader.How should the VPCA handle this conflict with the manager?

Scenario Four

The medical school in an academic health center recently implemented a problem-based cur-riculum, dramatically reducing the number of lectures given and substituting small-group learn-ing that focuses on actual patient cases. Both clinical and basic science faculty are feeling st, dental students took the basic course in microanatomywith medical students. The core lectures are still given but at different times that do not matchwith the dental-curriculum schedule.

The anatomists insist that they don't have time to teachanother course specifically for dental students. The dean has informed the chair of the Depart-ment of Anatomy and Cell Biology that some educational revenues will be redirected to the dentalschool if the faculty do not meet this need.How should the dean handle this conflict with the chair of the Department of Anatomy and CellBiology?

Scenario Five

The partners in a medical group practice are informed by the clinic manager that one physicianmember of the group has been repeatedly upcoding procedures for a specific diagnosis. This issuefirst came to light six months ago.

At that time the partners met with him, clarified the Medicareguidelines, and outlined the threat to the practice for noncompliance. He argued with their view,but ultimately agreed to code appropriately. There were no infractions for several months, butnow he has submitted several erroneous codes. One member of the office staff has asked whetherMedicare would consider this behavior "fraudulent."How should the partners handle the situation with the other physician partner?

3.3)Write an analysis of (750-1,000 words) on quality and performance improvement in health care.

Be sure to reference the module readings to support the development of your paper in apa format.