Lincoln Hospital Case Study

Case study, Pages 7 (1529 words)

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Introduction

This case describes a crisis situation that unfolds at the Lincoln Hospital, a 400-bed for-profit facility. At the root of the crisis is a dysfunctional relationship between the newly elected chief of surgery, Don, and the Operating Room (OR) director of 13-years, Mary. As a result of their discord, multiple exacerbated issues are occurring throughout the hospital. These issues are impacting the ability of the hospital to successfully perform the planned surgeries without incurring significant issues. The hospital has lost forty percent of the experienced OR nursing staff during the previous eight months, lessor experienced OR nurses are inefficiently replacing the more experienced nurses, physicians are threatening to conduct their surgeries in different hospitals, physicians are arriving late for scheduled surgeries, the staff is divided, and the necessary equipment is either not available or not the correct size resulting in delays and impacts to performing the surgeries.

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The president of the hospital is facing a daunting dilemma in trying to figure out how to bring this discord to closure and remedy the perturbating effects of this hostile relationship.

He believes the discord is responsible for the other systematic issues seen throughout the hospital. He considers firing Mary but quickly realizes she is an invaluable asset that he cannot afford to let go. At the same time, he realizes he needs to be accommodating to the surgeons or they will take their patients to another hospital. The competitive market adds complexity to the situation since the hospital is facing escalating costs, changes in regulations, and strict accreditation standards.

The president realizes the surgeons are loyal to the new chief of surgery and that he cannot afford to alienate or oppose the newly elected chief of surgery for fear of losing the surgeons to his competition. The president conducts his own initial investigation by speaking with both nurses and doctors.

He tells Mary and Don that they must resolve their conflict by meeting with each other until they resolve their issues; the meetings would begin immediately. To ensure Mary and Don follow through with his mandate, the president selects an impartial observer, the new executive vice president and chief operating office, Terry, to mediate the meetings. Both Mary and Don also ask their respective vice presidents to sit in on the meetings to ensure fairness in the process. Neither Mary nor Don wants to participate in these meetings and as such, the results of the meeting are less than fruitful. The initial meeting results in a hostile free-for-all. The president of Lincoln Hospital ultimately contracts with an Organizational Development (OD) consultant to remedy the situation. The OD consultant meets with Mary and Don separately to obtain answers to the following three questions:

1) What does he or she do well?
2) What do I think I do that bugs him or her?
3) What does he or she do that bugs me?

Mary and Don were able to see the positive characteristics about the other person through the process of answering the questions. Neither Mary nor Don had openly attributed their respect and admiration for the skills of the other person. Prior to participating in this exercise, their answers revealed the existence of ongoing and escalating frustrations concerning their inability to effectuate good interpersonal skills. As Mary and Don continue to participate in these meetings, they become better equipped to address their confrontational issues. They are better positioned and able to follow through with identifying specific problems, altering their reactions and their behaviors to effectuate co-existence in a productive way.

Contracting and Diagnosis Stages

The case did not elaborate much on the contracting stage between the president and the OD consultant. The case stated the president was in communication with the OD consultant. The president described a high level overview of the problem and subsequently hired the OD consultant with the expectation that the consultant would champion resolution of the dysfunction between Mary and Don. The OD consultant did not have the opportunity to talk with either Mary or Don prior to establishing a contract with the president. There was no agreement regarding the time to resolve the issues, or the acceptable solutions versus unacceptable solutions, other than the solution must include ongoing employment for both Mary and Don. The output of the contracting process is make a good decision about how to carry out the effort, define the resources needed to accomplish the tasks and document the assumptions, risks, and constraints. The contract ensures all parties are in agreement regarding the necessary commitments, support, and resources. Suggestions for establishing an effective contract would include carefully approaching the contracting process by laying out a model of how the OD process should flow.

The contracting process should include all parties, which would be inclusive of Mary and Don. This ensures they all have an input into establishing expectations for the process in terms of the desired outcomes, establish ground rules that all parties could abide by, and agree upon the time and resources that would be devoted to completing the goals within the given constraints. In addition, the OD consultant should state what his expectations are regarding the process. All parties involved need to be clear about their commitment of time and resources to the effort. In addition, Mary, Don, and the OD consultant should agree upon how they will work together. Some conversations may require confidential conversations or information. This type of information should be part of the contract.

The diagnosing process began largely from the description given to the OD consultant by the president and not as a collaborative effort among all affected stakeholders. As stated earlier, Mary and Don, as well as other affected members of the organization, were not engaged in the early meetings. The OD consultant may have a skewed view of the problem since he did not diagnose the problem but rather received the information second hand. His ability to identify the issues to focus on, how to collect data to measure the progress of a proposed implementation, and how to obtain agreement upon the process for assigning action steps is largely from the president’s view.

Suggestions for implementing a better diagnosing process would include engaging all affected parties, in a collaborative fashion, to understand all the issues, analyze them, and draw conclusions for action planning and intervention. They should be involved in actively developing appropriate interventions and implementations. An assessment, of the current state of the organization, will identify ways to enhance the organization’s existing functioning. A diagnostic model will point out what areas to examine and what questions to ask in assessing how they are operating. The diagnostic model should include inputs, design components, and outputs.

Third-Party or Other Types of Intervention

The third-party intervention is an appropriate intervention. It successfully generated positive results and reduced the friction between the two parties. However an element of tension still exists between Mary and Don. The consultant was able to get Mary and Don see past their differences and work together to resolve the issues in a productive way. This allows Mary and Don to see a side of each other they did not know existed, which allows the tensions to subside between the two. This also allows the organization to benefit since Mary and Don appear to be the catalyst for subsequent symptoms appearing throughout the organization.

Since much of the information, for diagnosing the situation, came from Mary, Don, and the other people affected by the discord, the diagnosis stage is utilizing accurate data to implement resolutions to the problems. This data is the basis of the intervention and as such it allows Mary and Don to make commitments regarding resolution of their issues. Mary and Don also have a new tool they can use in future meetings and interactions. Other possible interventions may include utilization of process consultations and team building events. Process consultations focus on the interpersonal relations and the social dynamics between groups. The team building intervention assists groups in working to evaluate their processes as well as establishing solutions to resolve problems.

Third-Party Effectivity and Next Steps

The third-party intervention is an effective intervention even though not all of the problems were completely resolved; perturbating effects still exist and fuel the discord between Mary and Don. Other issues are still present that need to be resolved throughout the organization. This intervention allows both parties, Mary and Don, to take ownership for the issues that resulted and changes the way they relate and interact with each other. It allows Mary and Don the ability to collaborate in the solutions and accept mutual responsibility for their part in the situation. In addition, they are now able to focus on solutions versus their problems.

Although there continues to be some conflict between Mary and Don, they are trying to work through their issues in a productive way. Process consultation should occur to ensure they are still making the needed progress. This method would allow flexibility regarding time commitments for all involved. In addition, repetitive practice in exercising these newly learned behaviors will result in institutionalized behaviors.