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Overview of Lincoln Hospital's OR problems

Question:

Case Study

Lincoln Hospital: Third Party Intervention

Soon after the election of a new chief of surgery, the president of Lincoln Hospital faced a crisis. Lincoln, a 300 bed for-profit hospital in south-western United States, was experiencing severe problems in its operating room (OR). Forty per cent of the OR nurses had quit during the previous eight months. Their replacements were significantly less experienced, especially in the specialty areas. Furthermore, not all could be replaced; when the crises came to a head, the OR was short seven surgical nurses.

Also, needed equipment often was not available. On several occasions, orthopaedic surgeons had already began surgery before they realised the necessary prosthesis (for example, an artificial hip, finger joint or knee joint) was not ready, or was the wrong size or had not even been ordered.

Surgery then had to be delayed while equipment was borrowed from a neighbouring hospital. Other serious problems also plagued the OR. For example, scheduling problems made life extremely difficult for everyone involved. Anaesthesiologists often were unavailable when they were needed, and habitually tardy surgeons delayed everyone scheduled after them. The nursing shortage exacerbated these difficulties by requiring impossibly tight scheduling; even when the doctors were ready to begin, the scheduled nurses might still be occupied in one of the other operating rooms.

The surgeons were at odds among themselves. Over 30 of them were widely regarded as prima donnas who considered their won time more valuable than anyone else’s and would even create emergencies in order to get ‘prime time’ OR slots – for which, as often as not, they were late. Worst of all, however, the doctors and nurses were virtually at war. Specifically, Don, the new chief of surgery, was at war with Mary, the veteran OR director; indeed, he had campaigned on a promise to get her fired.

Lincoln’s president was faced with a difficult choice. On the one hand, he needed to satisfy the physicians, who during the tenure of this predecessor had become accustomed to getting their way in personnel matters by threatening to take their patients elsewhere. The market was, as they physicians knew, increasingly competitive, and the hospital was also faced with escalating costs, changes in government regulations, and strict Join Commission on Accreditation of Hospitals standards. Could the president afford to alienate the surgeons by opposing their newly chosen representative – who had a large practice of his own?

On the other hand, could he afford to sacrifice Mary? She had been the OR director for 13 years, and he was generally satisfied with her. As he later explained;

Mary is a tough lady, and she can be hard to get along with at time. She also doesn’t smile all that much. But

she does a lot of things right. She consistently stays within her budget...

Furthermore, whereas Don had long been an outspoken critic of the hospital and was generally distrusted by its administrators, Mary was loyal, a strict constructionist who adhered firmly to hospital policies and procedures:

She is supportive of me, of the hospital, and of our interests. She doesn’t let the doctors get away with much.

Conflict between Don and Mary

She has been an almost faultless employee for years, in the sense that when she comes to work, gets the job done, never complains, and doesn’t make any waves. I really don’t’ understand the reason for the recent problems. I trust her and want to keep her. It would be extremely difficult to replace her.

The last point was a key one; a sister hospital had spent almost three years unsuccessfully trying to recruit an OR director.

After talking with both nurses and doctors, the president decided not to fire Mary. Instead, he told both Mary and Don that they must resolve their differences. They were to begin meeting right away and keep on meeting, however long it took, until they got the OR straightened out.

The results were predictable. Neither party wanted to meet with the other. Mary thought the whole exercise was pointless, and not saw it as a power struggle that he could not afford to lose. The president, who wanted an observer present, chose Terry, the new executive vice president and chief operating officer. Mary didn’t know Terry very well so she asked that her boss, the vice president of patient services, sit in. Don, who ‘didn’t trust either Mary or her boss as far as he could throw them’, countered with a request for a second of his own, the vice president for medical services.

When the meeting finally occurred, it quickly degenerated into a free-for-all, as Don and Mary exchanged accusations, hotly defended themselves, and interpreted any interventions by the three

‘observers’ as ‘taking sides’.

At this point, Lincoln’s president called me. We negotiated a psychological contract, where the president share the above historical information, described the problem as he saw it, and identified his expectations of me and for the project. I, in turn, articulated my expectation of the president. When then agreed to take no steps until I had interviewed both Don and Mary.

Later that afternoon, Don expressed his anger and frustration with the hospital administration and, most of all, Mary:

I don’t want to have anything to do with this lady. She is a lousy manager. Her people can’t stand to work for her. We don’t have the equipment or the supplies that we need. The turnover in the OR is outrageous. The best nurses have quit, and their replacements don’t know enough to come in out of the rain...All we want is to provide quality patient care, and she refuses to let us do that. She doesn’t follow through on things.

He particularly resented Mary’s lack of deference.

Mary’s behaviour is so disgraceful it is almost laughable. She shows no respect whatsoever for the physicians...She thinks she can tell us what to do and order us around; and I am not going to put up with it any longer. When I agreed to take this job as chief of surgery, I promised my colleagues that I would clean up that mess that has plagued the OR for years. I have a mandate from them to do whatever is necessary to accomplish that. The docs are sick and tired of being abused, and I am going to deal with this lady head on. If we go rid of her, 95 per cent of our problems would go away. She has just gone too far this time.

Difficulty in choosing between the chief of surgery and OR director

In his cooler moments, Don admitted that Mary was only partly to blame for the OR problems, but he still insisted she must be fired, if only to prove to the doctors that the hospital administration was concerned about those problems, and that something was being done. I am always a bit suspicious about the objectivity of someone who has reached the conclusion that someone must be fired. There is always something else that is going on that requires more investigation.

Clearly, both Mary and Don had strong needs to control other people’s behaviour, while remaining free of control themselves.

It was obvious from these initial interviews that Don and Mary were largely contributing to the OR problems; but it was also obvious that many others had a stake in the outcome of their battle.

Most of the doctors blamed the high turnover on the nursing managers’ inability to retain qualified personnel, whereas the managers blamed it on the doctors’ verbal abuse. And in face, a significant number of doctors were widely regarded by some of their peers as well as by the nurses as impatient, intolerant perfectionist who demanded for more of others than they did of themselves.

The next step was to identify specific problems for Mary and Don to address. They wrote their response on a sheet of newsprint, assigning vectors to represent the relative seriousness of the problem. Some of the most serious problems could be solved immediately; others were going to take longer, but at least Don and Mary now knew what their priorities had to be.

Finally, it became possible for them to agree on specific behavioural changes that might help. Don and Mary each defined what they wanted from the other and negotiated what they themselves were willing to undertake; the meeting was moderated and they wrote down the decisions. Because Mary and Don were interdependent, either could have easily sabotaged the other’s efforts. Therefore, in defining each action item, they were reminded to specify responsibilities for both parties:

  • What will Don (Mary) do to resolve this problem?
  • What will Mary (Don) do to help the other succeed?

This technique made both parties jointly responsible for resolving each problem and thus changed the whole dynamic of the relationship – from mutual isolation to collaboration, from denial of responsibility to acceptance of responsibility, and from a focus on problems to a focus on solutions.

During the next year, there were four more meetings with Don & Mary. Before each meeting, each participant was interviewed privately. At the beginning of each meeting, the participants gave general reports on what was going on, between Mary and Don and in the OR in general. In particular, each one was asked to list positive events and specific behaviours on each other’s part that they appreciated. They then reviewed the commitments they had made during the previous meeting. In almost every case, both Mary and Don had kept these commitments, thus building a basis of trust for further commitment during the latter part of the meeting. Where they had not kept the commitments, plans were made to ensure follow-through before the next meeting.

Third-party intervention to resolve the conflict

Internal conflicts within the company can affect the performance planned by the management. Through effective strategies and policies, it is possible for the management to overcome the problem that is associated with the performance. In the case of “Lincoln Hospital,’ the management had to face serious problem, due to the improper management skills followed by the authorities and the staffs. Internal conflicts can directly affect the planned performance of the management, and it has to be resolved in the best possible manner. In order to handle the challenges, the seriousness of the issue has to be analysed and corrective steps to handle the same has to be drafted. This would help in solving the problem and drafting the best policy through which the performance can be increased.

This report has been prepared on ‘Lincoln Hospital.’ Due to lack of management skills and differences in the management process, the performance of the hospital was seriously impacted. The department heads had differences in opinion and had absolute no trust on the management. This had impacted the performance of the hospital. The differences were quite strong, and some of them were genuine. Importance of third party intervention and operational development intervention has been discussed to highlight the steps that can be taken to handle the problem. Issues related to management, employee participation, and other factors have been discussed to find the best solution through which the issue can be solved (Adomi and Anie, 2005).

Lincoln Hospital was dealing with several challenging issues such as staff division issues that were identified among Don who played the role of new chief of surgery and other challenges were associated with the rate of turnover. There were scheduling related issues, delays with the process of communication etc. With respect to these issues, Don and other surgical members wanted to fire Mary who was positioned as the president of the hospital in the difficult scenario. The president thus decided not to fire her and asked Don and Mary to resolve the issues that were impacting the operations negatively.

The OD consultant made some plan on strategic management that contains diagnosis stage and third party intervention and also required the follow up process. Interviews were managed with Don and Mary to deal with problem identification and the follow up process took the form of meetings within the same year.

At the end, it was observed that there is a need to develop trust and successful as well as efficient commitments.

Problem faced by Lincoln  

Lincoln hospital faced serious crisis which had impacted the work ability of the management. The hospital had a capacity of 300 beds, but the management was not efficient in handling the task. Operating room didn’t have enough resources that were required for performing different tasks. The number of qualified nurses in the hospital was quite less, which increased the work tasks for the management. Surgeons had to postpone the surgery, due to lack of communication between different departments. Differences between the new chief of surgery Don and the OR director Mary had affected the performance of the hospital. As per the new surgeon, the operating rooms didn’t have enough facilities to handle the emergency situation. This had affected the quality of work that was meant to be provided to the clients. The OR director was unable to find the substitute of the professionals who had quit the job. 

Results of the intervention

Due to increase in the competition, it was necessary for the director to introduce effective rules that would enable the hospital to provide the best possible services to the clients. Managing conflicts including differences of opinion is one of the most important factors. The management in this case, has to adopt an effective communication method or intervention method that would help in analysing the issue. The surgeons didn’t have enough resources to carry out with the surgery process. This had affected the work, and the process for conducting the tasks. OR director had limited resources which made it quite challenging to fulfill the needs of the OR. The head of both the departments didn’t have trust and the decisions that were implemented by the management.

Some of the steps that can be followed by the management in resolving the issue included -

1. Assessing the problem – the problem faced by both the departments was related to the process adopted for executing the tasks that were considered to be important for the hospital. In this case, the challenges had to be analysed as this would highlight the steps that needs to be taken for handling the problem.

2. Focus - The core reason for the occurrence of the problem had to be analysed. In this process, the issue and its severity had to be discussed and resolved in front of the team head. This would help in finding the best solution that would help the management in resolving the problem (Attridge, 2009).

Decision - Based on the facts collected by the management, the top management could make the best decision that would control the issue. It included recruiting the best nurse and adopting the best strategy that would take care of the issue

There were problems associated with communication at Lincoln Hospital. The administration at the hospital was very difficult and required an effective interaction. With the help of case analysis, it has been discussed that the parties included with the health care work had to face certain issues associated with communication with each other from several departments. This also has developed challenges in policies designing and negotiations with different parties. It was considered to focus on several operational tasks. The major issues with policies drafting were known as operational issues. Third party intervention was also the problem at Lincoln hospital.

This has caused delays in the tasks that require to be managed for the people. Also, there has been a delay in the negotiation process which was meant to be recognized for successful activities of operations. It was important to develop and implement the strategies through change in the management activities and it could be done by the help of management. This needed to be managed with the help of improvement on quality services and the number of issues among members that impact the tasks quality needs to be proposed. Thus, management should follow and implement the correct strategy and improve the quality of services provided to the clients. Also, the major goal is to decrease the issues and maintain the policies which are the best services for the clients.

Interviewing Don and Mary

Lessons

The other step is to use the process consultations to maintain the record of progress and to involve the staff of lower level. The best approach to problem solving is to implement the effective strategy and resolve the challenges. Through the process of intervention, the problem can be effectively understood and possible obstacles can be managed such as improper planning, incorrect implementation strategy, incomplete knowledge and other challenges. It is vital to manage the challenges and to keep track of implementing the successful methods of communication that will help to solve the problem. This way, issues can be resolved. Team-building activities and exit interviews can be managed well and the stress of the employees will also be managed well with intervention approaches.

The success of the company depends upon the performance of the staffs. Department heads of the Lincoln hospital were not satisfied with the management and the decisions made by them.  Lack of resources had affected the performance of the hospital, and thus many nurses had quit the management. Two lessons learned were –

1. Internal differences between staffs and the management can impact the performance of the company

2. Management trust was quite important for successful business operational activities

The problem faced by the staffs and the managers of the company, regardless of its nature has to be identified and solved in the best possible manner. Management has to analyse the seriousness of the issue and draft the best possible policy through which the issue could be sorted out on a timely manner. In some cases, the strategic intervention becomes an important task. This would enable the management to introduce the changes that are required for the smooth conduct of the business activities. In this process, the management has to develop the best policy that would strength the relationship with various internal and external factors. The process for intervention has to be planned and implemented in an accurate manner (Dijkstra, 2004).

Internal competition, in many cases can be quite challenging and it can create serious problem for the employees and the management. Thus, the management has to develop strategies through which healthy competition that would motivate the staffs to perform better at the workplace. Staffs of the company have to encourage adopting positive methods through which the level of competition can be improved within the company. In some cases, the management needs to make collaborative steps through which the teamwork and efforts can be improved. This is necessary for improving the performance and introducing the changes that are necessary for handing the challenges that exists at the workplace. Positive and timely communication is essential for developing positive relationship with the clients and the staffs of the company. In this process, the company needs to adopt and implement an effective communication method that would help in overpowering the problem. Problem faced by the company can be effectively handled through team building process. In this method, the management can promote team participation that would help the staffs to discuss about the issue and find the best solution to the problem that affects the performance (Elliott, 2008)

Third party intervention was quite important for solving the problem faced by the Lincoln hospital. Mary was a tenured employee and has been successfully handling the challenges in the best possible manner. Don on the other hand was an experienced and qualified surgeon and was quite efficient in the work. Due to increase in the competition, the management was unable to find experienced staffs and nurses to take care of the issues faced by the hospital. Thus, it wasn’t possible for the management to terminate the services of either one or both the employees. The issue could be controlled or attempted to be resolved through third party intervention.  Such consultants can analyse the seriousness of the problem faced by both the department heads and try to find the best possible solution. The experts would act as a facilitator who would encourage the members to enter into healthy discussion. Mediators are quite successful in handling the issues and solving the seriousness of the problem. Both the parties were unsatisfied with the decision taken by the management to resolve the issue. Thus, mediators could encourage the parties and encourage entering into healthy discussion that would find a solution to the problem. The major problem in this case, was finding the best alternative that would serve the purpose of both the parties (Beersma, 2005).

Through operational development intervention process, the management could attempt to solve the problem that was faced by the department heads of the hospital. Through an effective strategy, it is possible to develop and implement variable and effective solution that would solve the problem faced by the parties within the company.

Some of the steps that can be followed for resolving the issue have been mentioned below –

1. Trust building - This was possible by indulging into positive discussion between the conflicting parties. Trust could be built by encouraging the members to discuss about the problem, and suggesting the best solution to cope with the issue.

2. Employee participation – The problem faced by the members had to be discussed in details, and this could be done through employee participation (Brewer, Mitchell, and Weber, 2002).

3. Measurements of the controls – Employees of the company are encouraged to work towards the goal achievement. However, it is the responsibility of the members to analyse the challenges that can impact the process related to goal achievement. For this, the required changes in the managerial strategies have to be analysed and implemented in the right manner (Bright, & Jones, 2001).

The assignments in the hospital have to be managed in an organized manner. If it has not been done, the management can face some challenges. To manage those challenges that are serious is really important. Therefore, the intervention of the third party also has been important. With this process, it has been analyzed that problems and answer needs to be found. Therefore, the process of intervention has to be effectively planned and managed in the correct way. This will create advantage for the company. The issues can be resolved with effective negotiation, contract preparation, proper diagnosis of the problem, etc. The data could be gathered to know the factors that impact the organization. Data should be analyzed successfully to manage the terms known as validity as well as reliability.

With the help of effective communication, the process can be improved. This will also help to deal with problem and find out the best possible solution through which the conflicts can be removed. Conflicts also impacts the performance and this is one of the main reasons, Lincoln hospital should find the best solution through which the issues can be resolved. Third party interventions usually impact the image and reputation of the company. Consultant should have gathered the own diagnosis and lower levels of the department should have been diagnosed.

Yes, it also focuses on issues with respect to conflicts among two or more people within the same work place in terms of Don and Mary. Conflict is neither bad nor good and it concentrates rationality between parties.

The intervention of intergroup conflict is developed to deal the departments within the organization to deal with issues. Therefore there should have successful outcomes.

Process consultation offers group members to know and improve the behaviors. It should include interaction, group norms, group problem solving, decision making and leadership as well as authority.

The third party intervention was effective with respect to the important activities of developing new competencies and skills to deal with the successful intervention. Third party intervention focused both Don and Mary to reflect the control and to deal with the issues with respect to problems. Sustaining momentum deals with energy to meet the commitment to organizational changes.

There are five activities that sustain momentum such as:

To offer the resources for change

To build the support system for change agents

To develop the new skills and competencies

To reinforce the behavior successfully

To stay the course

The third party intervention was known to be effective with respect to major tactics such as:

To diagnose the issues and to deal with the steps associated with the interviews

Planned model of change

The planning and implementation process was effective with the option of third party intervention process.

Model to diagnose the organizational system

Conclusion

Internal conflicts exist with different organizations, regardless of the operations and the size of the company. However, it is essential to find the best methods through which the problem can be solved by the authorities. Appropriate steps have to be taken to handle the severity of the issue, as this wouldn’t impact the operational activities of the company. The decision and steps followed by companies differs from each other. It depends upon the severity of the issue faced by the organization. In this case, the challenges have to be analysed, as this will help the management in taking corrective steps through which the conflicts can be resolved.

References

Adomi E and Anie S, 2005. Conflict Management in Nigerian University Libraries. Journal of Library Management, 27(8): 520-530.

Attridge M, 2009. Employee Work Engagement: Best Practices For Employers. Research Works: Partnership for Workplace Mental Health, 1, 1-11.

Beersma C, 2005. Conflict in organizations: Beyond effectiveness and performance. European Journal of Work and Organizational Psychology , 105-117.

Brewer N, Mitchell P, and Weber N, 2002. Gender role, organizational status, and conflict management styles. The International Journal of Conflict Management, 13 (1): 78-94.

Bright J, & Jones F, 2001. Stress, myth, theory & research. Harlow: Pearson Education Limited.

Dijkstra C, 2004. Conflict at work & individual well being. International Journal of Conflict Management , 6-26.

Elliott M, 2008. VP of Human Resources & Fund Development. (S. Graham, Interviewer)

Gonrig M, 2008. Customer loyalty and Employee Engagement: An Alignment For Value. Journal of Business Strategy, 29, 29-40

Harter J, Schmidt F, and Hayes T, 2002. Business-Unit-Level Relationship Between Employee Satisfaction, Employee Engagement, and Business Outcomes: A Meta-Analysis. Journal of Applied Psychology, 87, 268-279

Holbeche L, & Springett N, 2003. In Search of Meaning in the Workplace. Horsham, Roffey Park.

Ikeda A, Oliveira V, and Campomar C, 2005. Organizational conflicts perceived by marketing executives. Electronic Journal of Business and Organization Studies, 10 (1): 22-28

May D, Gilson R, & Harter M, 2004. The Psychological Conditions of Meaningfulness, Safety and Availability and the Engagement of the Human Spirit at Work. Journal of Occupational and Organizational Psychology, 77, 11-37.

Roberts D, & Davenport T, 2002. Job Engagement: Why It’s Important and How To Improve It. Wiley Periodicals, Inc, 21-29.

Robinson D, Perryman S, and Hayday S, 2004. The Drivers of Employee Engagement. IES Report 408. ISBN 1 85184 336.

Saks  A, 2006. Antecedents and Consequences of Employee Engagement. Journal of Managerial Psychology, 21, 600-619.

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