The "Case in Health Care Management" is a regular feature of The Health Care Manager. Readers are invited to analyze the problem presented in the case and develop a reasonable response to the situation.
In analyzing a case:
* Look for the principles that appear to be involved, and look for the applicability of rules of reason, common sense, and fairness.
* Seek help from published sources. Associate the concerns of the case with key words that describe principles, concepts, theories, or techniques, and look these up in texts on supervision and basic management.
* Make whatever reasonable assumptions you need to "fill in the blanks" in the information given.
* Keep your assumptions reasonable, and state your key assumptions in your conclusions.
* Recognize that there are few solutions to a case problem that are entirely right or wrong. You are dealing primarily with human behavior, and all people will not necessarily behave the same way in similar situations.
CORRECTION
Issue 32:3 (July-September 2013) invited readers to respond to the Case in Health Care Management entitled "Did He Have It Coming?" Because publication of the case response skips 1 issue, the response to "Did He Have It Coming?" should have appeared in Issue 33:1 (January-March 2014). However, it was erroneously included in Issue 32:3. A response to the case "Assignment and Reassignment" from Issue 32:1 (January-March 2013) should have been included in Issue 32:3. The following restates this case and provides the response that should have appeared in Issue 32:3 (July-September 2013).
"Assignment and Reassignment" (From HCM Issue 32:1, January-March 2012)
Carol Ames was director of in-service education at James Memorial Hospital. She reported to Ann Baker, assistant director of nursing, who in turn reported to Helen Carey, director of nursing.
One morning, as Carol sat working in her office, Ms Carey entered and said, "Come and have a cup of coffee, Carol. There's something I'd like to talk with you about."
When they had gotten their coffee and found seats in a quiet corner of the cafeteria, Ms Carey said, "How busy are you these days, Carol? There's something I'd like you to do for me."
Carol answered, "I'm almost overloaded right now. I don't have much time to spare."
"I didn't think your teaching schedule was too full just now, at least not since you finished the nursing leadership program," Ms Carey said. "What's taking up your time?"
"It's true that my class schedule is only moderate right now. That's probably why Ann just gave me a couple of new assignments."
Ms Carey asked, "What assignments?"
"For one thing, she's given me just 2 weeks to compile an inventory of instructional materials and training aids throughout the hospital. Also, she's having me do a report about the costs of supplying employee education. It's long and complicated, and it has to be submitted to the State Hospital Association by the first of the month."
Ms Carey said, "Well, it has suddenly become very important that we get moving on the development of our new nursing audit criteria. I think you suspected this was coming. We're under pressure from administration to do something about nursing audits, and we don't have much time to do it."
Carol asked, "Where do I fit in?"
Ms Carey answered, "You're in the best position to take charge of the nursing audit committee. It will be up to you to convene the committee as necessary and get the criteria developed on time."
"But what do I do about the inventory and the cost report? Surely, I'm not going to have time for everything."
"Of course you won't have time for everything," said Ms Carey. "Ann will have to find some other way to get the cost report done, and the inventory will just have to wait."
"Is Ann aware of this?" Carol asked.
"No," responded Ms Carey. "I want you to bring her up to date. And please stress the importance of the audit activity."
At this point, Ms Carey excused herself. Carol got a second cup of coffee and sat by herself to ponder the situation. She felt that her immediate supervisor, Ann, had been quite clear about what she expected over the coming weeks. However, Carol now found herself wondering how to tell her boss that her commitments had been changed by higher authority.
Questions:
1. What fundamental management error was committed?
2. What would you recommend that Carol Ames do about the situation in which she finds herself at present?
Response To: "Assignment and Reassignment"
This is a familiar problem involving conflict over a person's ability to serve 2 masters with any amount of satisfaction. In this scenario, the director of nursing, Ms Carey, violated 2 management principles, one more serious than the other, to achieve what she considered an effective and efficient delegation of authority and responsibility. Ms Carey bypassed the formal chain of command and delegated to an employee who was not her immediate subordinate (a move that in some quarters has been referred to as "hopscotch delegation"). This type of end run around the assistant director, Ann Baker, seems unwarranted in this circumstance. At best, the action could go unnoticed; at worst, it could undermine the confidence of Carol Ames in assistant director Baker or lead to further confusion and distrust.
The second and more common violation was of the unity of command principle. This violation places the in-service director, Carol Ames, in conflict with the desires of her immediate superiors. In this position, Ms Ames is forced to deal with potentially bruised egos of both her immediate supervisor and the director of nursing.
The delegation of functional authority to Ms Ames for control of the nursing audit is within the realm of Ms Carey's control. It is not a radical violation of the unity of command principle because the higher-level orders would also apply to all subordinates of the director of nursing, including Ann Baker. Carol Ames should immediately inform Ms Baker of the change in plans, and Carol should convey her willingness to assist with completion of the inventory and cost report immediately after fulfilling her obligations with the nursing audit.
A successful resolution to this problem will involve tact and communication as well as cooperation among the parties. The new assignments, particularly the inventory, may be sufficiently nonurgent that their delay or reassignment should cause no problems. In any event, Ms Carey was wrong in bypassing Ann Baker to delegate this assignment. She might best try to clarify the situation in a short meeting of the parties. Carol would do well to request such a meeting.
Additional Correction
Since this journal's introduction more than 30 years ago, "Let Us Hear From You," soliciting reader responses, has asked for responses to be limited to no more than 300 words. In 3 recent issues (32:2, 32:3, and 32:4), this maximum number of words was misprinted as 3000. Correction to 300 has been entered.
Proceeding with normal presentation of the case for the present issue.
CASE IN HEALTH CARE MANAGEMENT (ISSUE 33:2) (APRIL-JUNE 2014)
"You're the Boss"
"I don't think this is the approach to take at all," said accountant Harold Winslow to his manager, finance director James Ross.
This response had not been unanticipated; Ross, in his second month on the job, had already come to expect Winslow to oppose almost every assignment he handed out or every course of action he recommended. Ross was especially frustrated with his less-than-satisfactory relationship with Winslow because he recognized this long-time employee of the hospital as a capable accountant who was highly knowledgeable of health care finance and reimbursement.
Ross asked, "And why do you think it isn't right?"
"It just isn't, that's all," said Winslow, who then added, "It's unlike anything we've ever done. If this sort of thing really worked we'd have done it long ago."
"Was this plan ever considered? Or one like it?"
Winslow shrugged. "Don't know."
Ross took a deep breath. "Look Harold," he began, "I've got my orders-and there are orders involved-and I believe this is probably the best way of doing what we've got to do. And since you have more knowledge of this area than anyone else in the organization, I'll need you to take the lead on this project."
"Of course I'll do it, if that's what you're telling me to do," said Winslow.
"More than that," said Ross. "I need you to own the project, to innovate, to look at it in ways that never occurred to me. I need you to do the best job you can do on this."
Again Winslow shrugged, his mask of skepticism unchanged, and he said, "You tell me to do it, I do it. You're the boss."
After they parted, Ross could not help feel uneasy about the assignment, even though Winslow was technically the best person available.
Questions:
* What can Ross do to try to get Winslow to willingly apply his full knowledge and experience to the assignment?
* What might be behind Winslow's apparent lack of motivation, and how should Ross address this problem overall?
LET US HEAR FROM YOU
Readers are invited to submit their written analysis of this issue's case for possible publication in HCM 33:4 (October-December 2014). This is not a contest. Because a solution to a case may be neither completely right nor completely wrong, there will be no winners or losers. We will select 1 solution that appears particularly appropriate or relevant, or we may elect to publish excerpts from several proposed solutions.
Responses to this issue's "You're the Boss" should be submitted under the following conditions:
* Your response, not exceeding 300 words, should be emailed no later than August 15, 2014, to Charles R. McConnell, Editor, HCM, atmailto:[email protected].
* Your response should include your full name, title, organization, and e-mail address.
* The editor will notify anyone whose response is selected for publication. Selected responses will be subject to normal editing for language and style.
"It's His Job, Not Mine" (From Issue 32:4, October-December 2013)
As administrative manager of the hospital's diagnostic imaging department, you have found your workload increasing to the extent that you now definitely need assistance, especially with some of your nonmanagerial duties. One of the first tasks that occurs to you for possible delegation is your monthly statistical report. The report itself is fairly easy to create, but gathering the data is time-consuming.
You select an employee to do the report and you provide the necessary instructions. In doing so, you are careful to choose an employee who you believe is capable of doing a decent job and who has sufficient time available. The individual you select expresses no opinions or feelings for or against taking on the report.
Two days after assigning the task, you find that the report has not yet been started. You remind the employee; the employee tells you that the completion of other work has delayed the data gathering. You emphasize the need to get the report done on time, but the assigned person seems in no particular hurry to get into the task.
One day, you accidentally overhear a portion of a conversation in which the employee to whom you have assigned the report says to another employee, "[horizontal ellipsis]his lousy statistics, and I think he ought to do it himself. It's in his job description, not mine.
Instructions:
1. Describe what you might have done incorrectly in delegating the statistical report to this particular employee.
2. Decide what, if anything, you can do to try to correct the employee's attitude as revealed by his comments to the other employee.
Response to "It's His Job, Not Mine"
No reader responses to the case in HCM 32:4 were received. The following are a few points that might figure in a reasonable response to "It's His Job, Not Mine."
Delegation is fundamental to effective management. Delegation allows employees to feel valued as part of a team, and it gives them the opportunity to learn new skills. The department benefits overall, and managers can focus on those tasks that require special attention.
This case, however, involved assignment, not delegation, and the employee felt burdened rather than flattered by the increased responsibility. Clues should have been noted in the initial lack of enthusiasm, as well as the later procrastination and continued lack of enthusiasm. Narrow job descriptions can be a cause of the "It's not my job" malaise. Participative management will also be of value both in the short run and in the long run here. If managers influence, rather than assign, employees will be committed to invest time and energy in production and performance.
To influence this employee, various "perks" might be assigned to the job. If this employee is interested in moving into management, letting the employee present the report to administration might be of personal value. Perhaps, if the cover sheet for the report clearly lists the employee as author, this individual will be motivated by recognition. Giving the employee an afternoon at home to prepare the report is another strategy.
This employee may simply be unmotivated; however, if the manager uses the principles of participative management, employees will surface with an interest in furthering the goals of the department and themselves, not simply themselves.