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The "Case in Health Care Management" is a regular feature of The Health Care Manager (HCM). Readers are invited to analyze the problem presented in the case and develop a reasonable response to the situation.


In analyzing a case, take note of the following:


* 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.



As the admitting supervisor recently hired from outside, it did not take you long to discover that the morale in the department had been poor for quite some time. As you worked to become acquainted with your employees by meeting with each one alone, you quickly became inundated with complaints and other indications of discontent. Most of the complaints involved problems with the administration and the business office and the loose admitting practices of physicians, but there were also complaints from the admitting staff about other members of the department and a couple of thinly veiled charges concerning admitting personnel who "carry tales to administration."


In listening to the problems, you detected a number of common themes. You decided that a great deal of misunderstanding could be cleared up if the gripes were aired openly with the entire group. You then planned a staff meeting and asked all employees to be prepared to air their complaints-except those that would require identifying specific staff members-at the meeting. Most of your employees seemed to think that such a meeting was a good idea, and several assured you that they would be ready to speak up.


Your first staff meeting, however, was brief. When offered the opportunity to air their gripes, nobody spoke.


The results were the same at your next staff meeting 4 weeks later, although you were bombarded with complaints from individuals during the intervening period. This experience left you frustrated because many of the complaints you heard were problems of the group rather than of individuals.




1. What can you do to get this group of employees to open up about what is bothering them?


2. How might you approach the specific problem of one or more of your employees carrying complaints beyond the department, that is, "carrying tales to administration?"



Readers are invited to submit their written analysis of this issue's case for possible publication in HCM 26:1 (January-March 2007). 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 "The Silent Majority" should be submitted under the following conditions:


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


* The response should be postmarked no later than October 15, 2006, and should be mailed to Charles R. McConnell, Editor, HCM, 5943 Walworth Road, Ontario, NY 14519, or e-mailed by that date to the editor at


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


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


* Unused responses cannot be acknowledged or returned.



Imagine that you are the manager of health information management 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. Three of your employees are working supervisors, each looking after a few others while pursuing their own nonsupervisory work. 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 did not see the 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?


RESPONSE TO: "WHAT TO DO WITH THE SQUEAKY WHEEL?" (From HCM 25:1, January-March 2006, to appear in HCM 25:3, July-September 2006)

No reader responses were received for the case titled "What to Do With the Squeaky Wheel?" appearing in HCM Issue 25:1 (January-March 2006). Following are some thoughts that might appear in a reasonable response.


One solution might be to simply concede to the "squeaky wheel" and give her what she wants, immediately authorizing the requested help. The advantages of this include quieting the complainer and possibly getting more work accomplished on time. Disadvantages: demonstrating that subordinates can get what they want just by yelling loud enough, plus potential waste in that additional help might not be the real solution.


An oversimplified solution might be to replace the complainer with someone else. This could stop the complaining, but in addition to being unfair on its face, it fails to address the real problem.


Another answer might lie in calling her bluff, doing nothing for a week or so to see whether she carries out her threat. But this would be no more than an ego contest ("No employee is going to threaten me!") and counterproductive by possibly making a bad situation worse.


The only reasonable solution is to promise immediate action in the form of a study of the situation to determine what is really wrong and what can be done about it. The study should involve the complainer and commence within the present week.


The trap referred to lies in the fact that you have just been made aware of a real problem that should be addressed without delay, but the commencement of any activity can appear to some as though you are giving in to an employee ultimatum. This suggests that beginning activity be such that the chances of it being interpreted as "giving in" are minimized.


As to what caused the problem, both parties, "you" and your subordinate supervisor, must share the blame. For your part, you failed to pick up on numerous signs and signals that indicated a possible problem. And the "squeaky wheel" supervisor did no more than holler "help!" when in fact she should have done some investigation first to define the real problem and suggest how it might be approached.