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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.




"Since we started our total quality program I've gotten genuinely confused about who's really running the department," said supervisor Carrie Block. "I certainly don't feel like it's me these days."


"Why is that?" asked her friend, Janet Mason.


"We've got all these employee project groups working on lots of things that used to tie me up so much, and maybe that's good. But it seems to me like I'm just not doing some of the things I've always been paid to do."


Janet asked, "Like what?"


"Like making some of the really sticky decisions, like scheduling-who's going to work when has always been touchy-and like deciding on capital equipment purchases. These have always been tough, but I accept that. After all, it's what they pay me for. But I seem to have lost control."


Carrie continued, "It isn't bad enough that I've got a dozen people going off in their own directions talking about this 'empowerment' stuff. There's also the problem of 'Freddie the expert.'"


"Who's that? I haven't heard you mention a Freddie before."


"Just hired him a couple months ago," Carrie explained. "He seemed bright and willing to work, maybe too much so. Willing-to take over, apparently. He's never managed anything in his young life, but he's taken a couple of management courses and he has all the answers."


"Thus the 'expert'?"


Carrie nodded. "All the answers," she repeated, adding, "and always absolutely right-just ask him."


Carries sighed wearily and said, "Between Freddie always challenging what I say and telling everyone how to do their jobs, and these quality project groups who seem bound and determined to make all the decisions, I'm left feeling like I've been deposed. Who's the boss, anyway? And if it isn't me, what am I here for?"




1. What would appear to be the major problems Carrie is experiencing with her organization's total quality process, and what should be her true role in the organization?


2. What should Carrie be doing about "Freddie the expert"?




Readers are invited to submit their written analysis of this issue's case for possible publication in HCM 36:1(January-March 2017). 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 "Who's the Boss?" should be submitted under the following conditions:


* Your response, not exceeding 300 words, should be e-mailed no later than November 15, 2016, to Charles R. McConnell, Editor, HCM,


* 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.




(From HCM 35:1, January-March 2016)


You are the administrative director of the hospital's department of radiology. One of your more troublesome areas of late has been special procedures; you have chronically had difficulty recruiting and retaining special procedures technologists. You presently have your allotted full staff of 3 special procedures technologists, but these people are fully utilized, and at least 2 of them have recently made comments about the staffing level being inadequate for the workload.


Your senior technologist, Arthur Morris, has been especially vocal in his comments claiming understaffing in the department. Several times, and as recently as Monday of this week, Morris spoke with you concerning his perception of the need for another special procedures technologist. Today, Wednesday, September 9, you received the following note from Morris:


"As I suggested I would do in our conversation of Monday this week, I am going on record notifying you that additional technologist help for special procedures must be available by Monday, September 21. If you are unable or unwilling to provide another special procedures technologist, I will be unable to continue in my present position beyond Friday, September 18."




1. What should you do about the ultimatum delivered by Arthur Morris? Why?


2. Identify the key issue in the case and describe why it presents a significant problem.




No reader responses to the case in HCM 35:1, "Ultimatum,"' were received. Following are a few possibilities, some of which might figure in a reasonable response.


Has Morris finally gotten the attention of the administrative director? We certainly hope so. It is unfortunate, however, that he felt he had to threaten to resign to awaken the director to the presence of a problem.


What the director should do about the ultimatum is exactly what should have been done some time earlier, that is, start talking with special procedures personnel and others about workload and scheduling. That 2 of the 3 technicians have complained of inadequate staffing, and that the most senior technologist has been particularly vocal, should have suggested at least a strongly perceived problem. A perceived problem is fully as troublesome as a real one until it is addressed and either defined or defused. The administrative director has not been listening to the staff sufficiently to recognize the obvious-that there is discontent in the department involving issues of staffing and workload. The director should not simply commit more staff to special procedures without thorough study and analysis; added staff may not be the answer. Yet it is doubtful that the problem can be defined and corrected before Morris' self-imposed deadline arrives. The best the director can do under the circumstances is acknowledge-belatedly, unfortunately--the existence of a problem and show visible signs of getting to work on it. If that is enough for Arthur Morris, he will reconsider his resignation. This would make time for which a solution might be found. However, Morris might just as readily go through with his resignation.


Indeed, the key issue in the case as presented is Arthur Morris' ultimatum. He is essentially threatening management by telling it that if it does not do something he wants it to do, he will do something to make circumstances worse for them. This places the director in a potential no-win situation for one who has just been awakened to a significant problem: The director can immediately cave in to what amounts to subordinate blackmail and add staff, thus sending a dangerous message to the rest of the organization, or take the chance of Morris actually resigning. Neither alternative is acceptable, so the director's only real choice is to acknowledge the likely existence of a staffing problem and begin at once to apply visible effort to the problem's definition and solution in a manner that, preferably, involves the special procedures staff.