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On Monday of this week, business office manager Carrie Owens learned that one of her key staff members had decided not to return to work after her maternity leave. Carrie learned this first from one of her employees, but it was confirmed later that day by the hospital's employee health service.


That same day, she was asked by two employees whether the hospital's new policy on vacation accruals would affect their vacation banks. Because she had heard nothing on this subject, she asked them where their concern had come from. One employee said she saw it in writing in the accounting office; the other said, "Barry told me" (Barry being the director of patient services and, not incidentally, Carrie's immediate superior). It was Wednesday before Carrie received a copy of the policy change.


The two foregoing occurrences left Carrie feeling that she was a step behind most of her employees in receiving information of importance to her department. This feeling was intensified on Thursday. That day, she received a call from a fellow manager asking why she was not at an important meeting that was already starting. Hastily saying that she knew nothing about the meeting, Carrie dropped everything to attend. When she returned to her department after the meeting, in her mail tray she found an announcement for the meeting. It had not been there that morning when she emptied the tray as she did each day, but it was dated five days earlier.


By the end of the week, Carrie was feeling considerable frustration with communication practices within the organization. She said to a good friend over breakfast on Saturday, "I feel totally out of the mainstream of information, especially when my employees hear about things before I do. Why doesn't anyone tell me what's going on?"




Unlike previous cases, this is not asking the reader to describe what has been done wrong. We can safely conclude that, for whatever reasons, communication within the organization leaves much to be desired. Rather, you are asked to suggest what Carrie can do to improve her overall communication posture in the organization and generally increase her chances of receiving the information that she needs to do her job. In other words, what can she do to improve organizational communication for herself?


The "Case in Health Care Management" is a regular feature ofThe 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 seem 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.




Readers are invited to submit their written analysis of this issue's case for possible publication in HCM 36:4 (October-December 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 seems particularly appropriate or relevant, or we may elect to publish excerpts from several proposed solutions.


Responses to this issue's "Why Doesn't Anyone Tell Me?" should be submitted under the following conditions:


* Your response, not exceeding 300 words, should be sent via e-mail no later than August 15, 2017, 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 35:4, October-December 2016)


"I'm really up a tree about what to do with Kelly," said nurse manager Jane Babson. "I know she's genuinely ill quite often, or at least I know she's asthmatic and some of her absences seem to relate to that. She's out often enough that her sick time is always used as fast as it's earned, and she's chipped away a lot of her vacation bank to cover illness. Yet, she's never out long enough to go on disability so I could get some reliable temporary coverage for a while."


Personnel representative Diane Jones asked, "What happened with the other absence problem you mentioned some time ago? Wilson? Or was it Williams?"


"Wilson," Jane said. "That one's pretty clear cut. Sick time taken as fast as accrued, patterned absences-always before or after scheduled days off. Good health, at least by all appearances. She's even been seen at the mall a couple of times when she was supposedly sick."


"No problem dealing with Wilson," she added. "A file full of warnings, next time she's out."


"What about Kelly?" Diane asked.


"I've tried to work with Kelly about the time she's missing. After all, I've got a unit to staff and whether somebody is truly ill or just faking it, the work still isn't getting done. And Kelly's pretty quick to claim that she's really sick-not like those others and their so-called mental health days, as she puts it-and she's come pretty close to threatening me with some kind of legal action if she gets disciplined for absenteeism."


Jane sighed heavily and asked, "Diane, what can I do about Kelly? And can I do something different about Wilson?"




Put yourself in the position of personnel representative Diane Jones and summarize the advice you would present to Jane Babson.



No reader responses to the case in HCM 35:4, "But She's Really Sick," were received. The following are a few possibilities some of which might figure in a reasonable response.


The personnel representative being asked for advice by Supervisor Babson might start by reminding Jane of something she herself said, "After all, I've got a unit to staff and whether somebody is truly ill or just faking it, the work still isn't getting done." Regardless of why any particular employee is absent on any given day, the fact remains that the work is not getting done at all or is getting done only at the additional expense of replacement help or overtime. The key, of course, in applying the disciplinary process is consistency; whatever action is taken with one person for a violation of policy must also be applied with another for the same violation regardless of the supervisor's belief in possibly differing motivations or circumstances behind the behavior.


Jane needs to be dealing with both Kelly and Wilson according to the organization's policy addressing absenteeism. She cannot allow herself to "go easier" on Kelly because of apparently genuine health problems and implied threats of legal action. The disciplinary process should include referral to an appropriate source of counseling assistance, someone in a position to help assess individuals' problems and suggest how to address them. The best source, certainly in Kelly's case, is the organization's health service employee. Moreover, appropriate counseling might be provided by an employee-relation professional, especially in cases such as Wilson's that might involve mostly employee motivation and attitude.


It is extremely important for both employees to be given the full benefit of all of the organization's applicable processes. In the case of an individual such as Kelly who may well be dealing with a true chronic health problem, the solution may be found in some form of medically advisable leave, either continuous or intermittent, under the Family and Medical Leave Act. It is possible that a leave or other form of accommodation could help to address the supervisor's staffing problem and to ensure the individual's continuing employment.