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92603 Managing Quality Risk And Cost In Health Care

tag 0 Download 4 Pages / 845 Words tag 13-07-2021


Camphorwood Hospital is a small-sized, 100-bed hospital in a city of approximately 90,000. It is well equipped for inpatient care and has a surgery team that is a matter of special pride to the Local Health District (LHD) Board and the Hospital's Director. None of the LHD board members live in the hospital's immediate neighbourhood, though they know the area well.

Until 10 years ago, Camphorwood was in the middle of a growing community. Now, however, it is on the northern edge of a city which is shrinking. The community is now largely made up of low-income families, as well as a growing number of young families and some professionals who have moved in to service the community.  

As a result the clientele of the Hospital is changing. One other factor is affecting the demand on the Hospital.  There is only limited access to bulk billed general practice, as the local General Practitioners are over-subscribed. There is a two month wait to see a GP, and the fee for a 15-20 minute appointment is $90. As a result, the community is going to Hospital instead of their local GPs. The hospital, through its emergency department, has now become the main source of medical care for residents who cannot afford, or cannot wait for basic medical care.

Like most hospitals, Camphorwood is facing financial difficulties. Because of the location of the hospital and the challenges in the community, it has become increasingly difficult to attract new practitioners of all types and harder to retain existing staff. Although the hospital director is somewhat sympathetic to the medical care problems of the community, she sees her first priority as building the strengths of the organisation by increasing opportunities for medical staff to undertake more advanced training, and by adding additional facilities that should make it more attractive for staff to stay on rather than go elsewhere. She has wondered whether it might be a good idea to set up a joint hospital-community health centre, but this did not eventuate because of problems involved in trying to find the right location. As a result, this project has been put aside.

Residents in the local community have organized a Camphorwood Hospital Action Group (CHAG). They are very concerned that given the hospital is the health hub of the community, it should start offering other services, especially in areas such as health promotion and preventive medical care, and Camphorwood should improve and expand its outpatient facilities, establish a health centre with day care facilities, and train a health team who would travel around the community administering diagnostic tests. They feel that Camphorwood Hospital is theirs, and to them, this is what a local hospital should be doing for the residents.

A month ago the CHAG sent a letter to the Director asking that the hospital initiate these efforts and requesting that she meet with them to discuss how the community and the hospital could work together. Although the community is very worried about the rise of medical problems in the community and is upset fact that Camphorwood has not acted before this of its own volition, the letter was completely unfriendly.

To date, the letter has not been answered.

Three days ago, the director and the chairman of the LHD board announced the acquisition of a site about 15 blocks from the hospital on which it said it would build a new support services building, eight apartments for visiting and new medical and nursing staff, and a staff parking lot, with a shuttle bus service to the hospital grounds.

On learning of the plans, the leaders and members of the CHAG were so angry that they decided to protest outside the hospital until the board met their needs.

The day before yesterday, about 50 CHAG supporters blocked the administrative entrance to the hospital with banners and signs, saying they would not to leave the ground until the hospital agreed to meet the following demands:

  1. Replacement of the LHD Board with community elected members;
  2. A 100 per cent increase in outpatient facilities;
  3. Establishment of a health centre and a day care facility on the newly acquired site;
  4. Replacement of the director by one chosen by the community.

While the hospital director indicated that she would be glad to meet with the group's leader to discuss the matters raised in its letter, she also stated quite forcefully that she considered the new demands arrogant and destructive and that, in any event, she would not meet under duress (i.e., as long as the protest continued).

The CHAG said it would not leave until a meeting took place and their demands were accepted.

The protest started two days ago. This morning the hospital's lawyers moved to secure an injunction against the protest. Some members of the CHAG were present in the local court at the time, and vocally resisted the application.

The judge reserved her decision, stating that to grant an injunction might only make the situation worse. She noted that both the hospital and the CHAG would have to learn to live together for their own joint best interest. She therefore ordered the parties to meet to try to work out the problems between them or she would be forced to decide for them.

The meeting has been scheduled for later today.

Negotiation Preparation Questions (word limits are approximate only).

Choose one party – either the Hospital Director or the Leader of the CHAG and answer the following questions by reference to the scenario and to your reading of the negotiation reading material:

  1. What are your interests in this negotiation
  2. What are your negotiating partner's interests
  3. What do you want to ask your partner about his/her interests
  4. What options could you propose to meet your key interests and theirs
  5. What standards or criteria could you use to decide among several possible options
  6. What interpersonal issues or difficulties might emerge in this negotiation If you do encounter some difficulty, how could you “separate the people from the problem
  7. What is your BATNA (Best Alternative to a Negotiated Agreement)
  8. Based on the analysis of your BATNA, what is the minimum you would be willing to accept.
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