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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.



Imagine that you are the manager of health information management (HIM) at County Memorial Hospital. You have a mix of full-time and part-time employees amounting to a staff complement of 20 full-time equivalents (FTEs). Three of your employees are working supervisors, each looking after a few others while pursuing their own nonsupervisory work as well. One of these, the transcription supervisor, is expected to devote 60% of her time to transcription work and the remaining 40% to supervision.


Several times in recent months the transcription supervisor has mentioned that the backlog of work was growing and that she needed more help. She has never been more specific than saying "more help" was needed, and her complaints seemed little more than passing remarks offered without preparation or forethought. Because you have been under pressure from a number of directions and the transcription supervisor's complaints seemed no more than chronic grumbling, you have not seen possible problems in the transcription group as a particular priority.


However, today-Monday-the transcription supervisor interrupted you in a meeting and demanded, "I need another half-time transcriptionist, and I mean right now! I'm tired of waiting and tired of being ignored, and I'm sick of being overworked and taken for granted. If something isn't done about this by Friday I'm out of here you can find yourself another transcription supervisor."




1. Propose at least 3 possible solutions to the problem and note the potential advantages and disadvantages of each.


2. The case places you in a trap. Describe the trap, explain why it is a trap, and suggest how to proceed under the circumstances.


3. Explain what you believe to be the general problem or condition that caused the specific problem described in the case. Who is responsible for the matter, and what can be done to correct the cause?




Readers are invited to submit their written analysis of this issue's case for possible publication in HCM 25:3 (July-September 2006). 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 "What to Do with the Squeaky Wheel?" should be submitted under the following conditions:


1. The analysis should be typed and double-spaced. It should not exceed 300 words.


2. The response should be postmarked no later than April 15, 2006, and should be mailed to: Charles R. McConnell, Editor, HCM, 5943 Walworth Road, Ontario, New York 14519, or e-mailed by that date to the Editor at


3. The response should include the responder's full name, title, organization, and complete mailing address.


4. The editor will notify anyone whose response is selected for publication. Selected responses will be subject to normal editing for language and style.


5. Unused responses cannot be acknowledged or returned.



"I have a particular part-time employee who is giving me a great deal of grief," said business office manager Darlene Swift, "and I'm looking for advice on how to deal with her."


"What's she doing?" asked human resources representative Ellen Francis who then added, "Are you going to tell me it's Jennifer Wilson again? The one we spoke about maybe six months ago?"


"Yes, the same. I'd forgotten we talked about her briefly. I tried counseling like you suggested, but nothing changed. If anything, things have gotten worse."


"How so? Fill me in; I forgot the particulars of our earlier discussion."


Darlene offered, "Jennie's still part-time, 20 hours a week. But she takes more sick time than any full-time employee. She's out frequently, and whenever she returns she automatically expects that someone will have completed anything she left unfinished. She expects someone else to clear up her backlog any time she's out, and unfortunately that's what's been happening."


Darlene continued, "And whenever she's asked to work extra time help cover for vacations or others' illnesses, she always refuses. With what usually sound like good reasons."


Ellen asked, "How long has she been employed here?"


Darlene sighed. "Maybe that's part of the problem. She's been here forever, close to 25 years. In fact, she told me recently that she'd given her share of extra effort to the hospital over the years and that it was about time the hospital gave back to her. As she puts it, 'This place owes me'."


"Have you talked about her behavior recently? Specifically, the absences?"


A shrug. "I tried counseling. About absences. That's when I got the speech about expecting the hospital to give back to her."


"Still concerning the absences, any disciplinary actions?"


"No," Darlene answered. "I don't believe she's ever been disciplined for anything."


"Okay," said Ellen. "Let's take a look at her file, access her attendance records, and see what we might be able to do about Jennifer."




1. Imagining yourself in the position of human resources representative Ellen Francis, what advice would you offer Darlene for dealing with her troublesome employee, Jennifer?


2. How could Darlene have avoided-or at least minimized-the present problem?


3. What personnel policies are likely to be in place to assist Darlene in addressing difficulties such as those presented by Jennifer?




No reader responses were received for the case titled "This Place Owes Me" appearing in HCM Issue 24:3 (July-September 2005). Following are some thoughts that might appear in a reasonable response.


Human resources representative Ellen Francis would most likely be advising Darlene to effectively start over in dealing with Jennifer Wilson, especially if there is nothing contrary in Jennifer's personnel file. We are told there have been no disciplinary actions, and if informal counseling sessions are documented at all, such notes will likely reside in Darlene's personal files. Therefore, if there is no record of any difficulties or any attempts at correction, for all practical-and legal-purposes, she has never done anything wrong. If something is not on paper, it is regarded as never having occurred.


It should be obvious that Darlene could have avoided or at least minimized the present problem by using the organization's progressive discipline policy, which usually begins with counseling, to address chronic absenteeism or sick-time abuse when Jennifer's conduct first reached the problem threshold. And of course Darlene should be applying such policies equally to all other employees who exhibit behavior similar to Jennifer's. It would also be helpful if Darlene was able to implement a rotational scheme for covering vacations or illnesses or for assigning overtime.


Needed policies are primarily those that address employee counseling and progressive discipline, especially as concerns attendance.


The problem Jennifer presents is one of attitude as much as behavior, and it is a fundamental premise of discipline that one cannot discipline for "attitude" but must focus on behavior. The organization "owes" Jennifer certain considerations that have been extended as part of the employment relationship, but Jennifer owes the organization reasonable job performance and adherence to rules and regulations. Should Jennifer be treated more favorably than other employees who do the same work simply because she has worked there longer? Perhaps in some small ways like observing seniority in vacation scheduling or such, but not to the extent of exempting her from rules and regulations that others must observe.