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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.




When head nurse Sylvia Miller was faced with the opportunity to promote one of her staff members to a charge nurse capacity, she found that she was not lacking apparently qualified employees. In fact, after sorting through several possibilities, Sylvia was left with 2 equally appealing candidates. Jane Wilson and Hilda Ross, in Sylvia's opinion the 2 best nurses on the floor, appeared equal in qualifications and experience in just about every respect.


It was evident to Sylvia that Jane and Hilda both wanted the position; each had made her desires known to Sylvia upon first learning that the position would be available. Both Jane and Hilda were energetic, willing, and apparently career oriented.


Sylvia eventually made her choice and promoted Jane Wilson to charge nurse. Although she did not discuss the ultimate basis of her decision with anyone, Sylvia admitted to herself that her decision was based largely on personality-Jane seemed friendlier than Hilda and more able to relate to other people on a one-to-one basis.


Jane Wilson eagerly accepted the promotion and plunged into her new role with enthusiasm. Hilda Ross expressed some initial disappointment, which seemed, at least to Sylvia, to dissipate rapidly.


However, 6 weeks after Jane's promotion, it was plain to Sylvia that Hilda Ross had changed both her outlook and her behavior. Where previously Hilda had always seemed willing to do more than her share of work, she now seemed content doing just enough to get by. Although never overly talkative or socially outgoing, Hilda now seemed all the more silent and withdrawn. Worst of all, at least to Sylvia, was Hilda's apparent practice of resisting instructions from the new head nurse and creating obstacles for Jane.


Sylvia realized that she had a problem requiring her active involvement when she overheard Hilda Ross grumbling about how "a person has to be the head nurse's buddy to get anywhere around here."




1. How might unintended personal bias here have intruded in Sylvia's selection of Jane over Hilda?


2. What do events subsequent to Jane's promotion have to say about Sylvia's choice of a charge nurse?


3. How should Sylvia go about dealing with Hilda Ross?




Readers are invited to submit their written analysis of this issue's case for possible publication in HCM 35:2(April-June 2016). 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 one solution that appears particularly appropriate or relevant, or we may elect to publish excerpts from several proposed solutions.


Responses to this issue's "Sylvia's Choice" should be submitted under the following conditions:


* Your response, not exceeding 300 words, should be e-mailed no later than February 15, 2016, 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.




Kay Thatcher, director of staff education, decided she had to get organized once and for all. Recently, her workdays had been running well beyond quitting time, cutting noticeably into the time required by her family responsibilities, but instead of going down, her backlog of work was growing.


Inspired by an article she read about planning and setting priorities, Kay decided to try planning each day's activities at the end of the preceding day. This past Monday, Kay came to the office with her day planned out to the last minute. During the morning, she had to complete a report on a recent learning-needs analysis, write the performance appraisals of 2 part-time instructors, and assemble the balance of the materials for a 2-hour class she was scheduled to conduct that afternoon. After lunch, she had to conduct the class, complete a schedule of the next 3 months' training activities (now 10 days overdue), and prepare notices-which should have been posted this very day-for 2 upcoming classes.


Kay got off to a good start; she finished the report before 10:00 am and turned her attention to the performance evaluations. However, at that time, the interruptions began. In the next 2 hours, she was interrupted 6 times-there were 3 telephone calls and 3 visitors. The calls were all business calls. Two of the visitors had legitimate problems, one of them taking perhaps 30 minutes to resolve. The other visitor was a fellow manager simply passing the time of day. Neither performance appraisal was completed, and the training materials were assembled in time for the class only because Kay threw them together during lunch while juggling a sandwich at her desk.


Kay's afternoon class ran 20 minutes overtime because of legitimate discussion and questions. When she returned to her office, she discovered she had a visitor, a good-humored, talkative sales representative from whom Kay sometimes bought materials, who "happened to be in the area and just dropped in." The sales representative stayed for more than an hour and a half.


Once again alone, Kay spent several minutes simply wondering what to do next. The performance appraisals, the 3-month schedule, the class notices-all were overdue. Deciding on the class notices because they were the briefest task facing her, she dashed off both notices in longhand and asked the nursing department secretary to type them, run them off, and post them immediately. Then she set about to tackle the training schedule.


When Kay next looked up from her work, it was nearly an hour past quitting time. She still had a long way to go on the schedule and had not yet started the 2 performance appraisals. As she swept her work aside for the day, she sadly reflected that she had not accomplished two-thirds of what she intended to accomplish that day despite all her planning. She decided, however, to try again; when she could get a few minutes of quiet time late in the evening, she would plan out her next day's activities.


On her way out of the hospital, she paused at the main bulletin board to assure herself that the class notices had been posted. The small satisfaction she felt when she saw the notices vanished instantly when she discovered that both were incorrect-the dates and time of the 2 classes had been interchanged.




1. What errors did Kay commit in her approach to planning and to the establishment of priorities?


2. In what respects could Kay have improved her use of time on the Monday described in the case?




No reader responses to the case in HCM 34:2, "Where Does the Time Go?" were received. Following are a few possibilities some of which might figure in a reasonable response.


Kay Thatcher had no real plan for Monday. She had only an outline without an agenda for resisting others' demands or requests and no defense against her own human nature. She surely felt that she was organized; she was perhaps even over-organized to the extent of scheduling out all of her time, leaving little or no room for the unanticipated.


One of the most difficult parts of managing our time is recognizing that we are the biggest culprits when it comes to wasting our time. It is much easier to blame drop-in visitors, meetings, inadequate equipment, paperwork, phone interruptions, or crises. The real cause lies in the way we allow these interruptions, the ways in which we allow our time to be wasted. To make real progress in managing our time, we need to be prepared to change habits and be willing to make changes in the way we work each day.


A written daily plan is the most important tool in time management. Without it, our days may well become a mix of minor crises, interruptions, and frustrations. But again, that daily plan should leave time for contingencies.


Time management means performing the most important task first and giving that task our full attention. If nothing else in our daily plan gets done, we can still feel good in having completed our top priority.


Making time work for us is a challenging task. Whether through reading, participation in seminars, workshops, or in-house training programs on time management, Kay can apply techniques such as improved planning, tactful telephone screening, effective delegation, task prioritization, and self-discipline to make a real change in her daily work life. These changes may reduce stress, improve productivity levels, hasten progress toward completing tasks and accomplishing goals, and result in a healthier balance between personal and professional lives.