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.
DEALING WITH THE REPEAT OFFENDER
"So I slipped up and made a little mistake," said chemistry technician Adam Williams. "All that proves is that I'm human, that maybe I'm a little careless once in a while-like everyone else is."
"I can't call your behavior carelessness," said laboratory supervisor Elsie Cleary. She slid a piece of paper across her desk to Adam and continued, "I have to call it negligence, and that's what this warning notice says."
Adam scowled and said, "I don't deserve a warning, and certainly not for negligence." He spread his hands and added, "What am I supposed to be-perfect? I can't make an honest mistake once in a while?"
"You can't make mistakes like this once. The test request was clearly marked stat but you logged it in as routine and it sat there for several hours."
Adam shrugged and said, "Nothing happened to the patient, did it?"
"No," Elsie answered, "but Dr Baker ordered it stat because of this particular patient's history. Something could have happened-we're just lucky it didn't."
"So nothing happened," Adam repeated, "but I get a warning in my file? If a warning's supposed to be a form of punishment, how come I'm punished for something that didn't cause any harm?"
Elsie said, "Adam, you're all by yourself every night at the satellite. We must be able to depend on you to process all requests according to procedure and to perform all stat work as it's received."
Adam simply scowled at the warning notice as Elsie added, "And this sort of thing has got to stop. This is the fourth conversation we've had like this, and the most serious yet."
"Fourth?" Adam's eyebrows rose.
Elsie nodded. "In just under 3 years."
"I can't believe you'd hold something against me that happened 3 years ago. A warning that old ought to be wiped out. You've got no business using that against me."
"I'm using it only to point out a pattern. You seem to go along fine for 8 or 9 months or so, then up comes another major problem."
"Just bears out what I said before, "Adam said. "I'm human. I make mistakes. And 8 or 9 months since the last mistake entitles me to a clean slate."
"I can't agree," Elsie said. She handed Adam a pen and added, "Please sign the form to show that we've discussed this. You can note any objections in the space at the bottom. And should we have such a conversation again, you may find that more than a written warning is involved."
Questions:
1. Consider Elsie's statement, "You can't make mistakes like this one." Is this a valid statement? Why or why not?
2. What is wrong with Adam's description of a warning as "a form of punishment?"
3. How would you deal with the repeat offender if you were in Elsie's position?
LET US HEAR FROM YOU
Readers are invited to submit their written analysis of this issue's case for possible publication in HCM 26:2 (April-June 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 "Dealing With the Repeat Offender" 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 January 15, 2007, 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 [email protected].
* 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.
NO LONGER "ONE OF THE GANG"
After working 8 years as a staff nurse on a medical/surgical unit, Julie was appointed nurse manager for that unit. Following a staff meeting at which her promotion was announced, Julie found herself the center of a group of 3 of her coworkers offering their congratulations and making other comments.
"I'm really happy for you," said Sarah. "But I suppose this means our car pool is disrupted. Your hours are bound to be less predictable now."
Elaine said, "And the lunch bunch, too. Management commitments, you know." The emphasis on "management" was undeniable, and Julie was not at all sure she was happy with what she was hearing.
Jane offered, "Well, maybe now we can get some action on some age-old problems. Remember, Julie, you used to gripe as much as we did."
"We've all griped a lot," Sarah agreed. "That's been sort of a way of life around here." Her tone changed and her customary smile faded as she added, "Now, Julie's going to be in a position where she can do something, so let's hope she doesn't forget who her friends are."
Elaine and Jane looked quickly from Sarah to Julie. For an awkward 10 seconds or so, nobody spoke. At last, someone passing by spoke to Julie, and as Julie turned to respond, the others went their separate ways.
Questions:
1. What possible advantages might Julie have in becoming manager of this group of which she has long been a member?
2. What are the possible disadvantages that may present themselves to Julie?
3. If you were Julie, how do you believe your promotion would affect your relationships with your former coworkers?
RESPONSE TO: "NO LONGER 'ONE OF THE GANG'" (FROM HCM 25:2, APRIL-JUNE 2006, TO APPEAR IN HCM 25:4, OCTOBER-DECEMBER 2006)
No reader responses were received for the case titled "No Longer 'One of the Gang'" appearing in HCM Issue 25:2 (April-June 2006). Following are some thoughts that might appear in a reasonable response.
As the supervisor of a group of former peers, Julie will have the advantage of already knowing the strengths and weaknesses of the people reporting to her. She will also know, based on past behavior, which employees are likely to exhibit attendance or disciplinary problems. As a long-time member of the unit, she may be privy to personal information or have knowledge of personal idiosyncrasies that may enable her to select and apply effective motivational techniques. She knows the people.
The disadvantages may be troublesome for Julie to deal with. She may have difficulty being taken seriously by her former peer group; these people have responded to Julie in a particular way for several years, and it may be difficult to change that response pattern. There might also be resentment from others in the group who thought they were more qualified, or that, perhaps, someone else should have been the one to be promoted. There may even be some who simply resent another's good fortune on general principle. Julie may also be uncomfortable giving instructions to her friends or pointing out errors to them. Disciplinary matters may also present problems for her.
Julie must be prepared to deal with the likelihood that she will no longer be thought of as "one of the gang." It is a rare case in which one who has been promoted can remain a member of the social group in good standing. The immediate effects may be mostly negative, and unless Julie's direct superior prepares her for them, she may be in for some difficult times. Her membership in the car pool and the lunch bunch may be among the first things to change.
There is often an "us-and-them" mindset in the working world, suggesting that "If you are one of them (management), you cannot be one of us." If Julie realizes this and accepts the fact that she cannot be all things to all people, she should have every chance of success.