The Practice Case

INSTRUCTIONS: The practice case enables you to sharpen the ideas and methods you have studied by applying them to a realistic business problem. The answers you provide to the questions are not submitted to Educational Services for grading. Rather, as its name implies, the practice case gives you the chance to practice for the examination case by having you put your newly acquired knowledge to work through analyzing and solving problems in a realistic setting.

After reading the case, summarize and analyze the situation as it has been presented. Ask yourself “What is really going on here?” Read and answer the review questions, and then prepare a written analysis and solution.

ASSIGNMENT

After reading the case, review the situation of the various managers at Memorial Hospital as they attempt to identify reasons for dissatisfaction with their relationships and performance. Place yourself in the role of an external consultant to the Executive Director, and prepare a report in the form of a memorandum to the top management of Memorial Hospital. Clearly indicate what you feel are planning problems, assess present organization and staffing decisions, analyze the leadership styles demonstrated, assess the existing control systems, and suggest areas that need improvement.

THE HEALTH-CARE INDUSTRY

In the 1990s, the health-care industry continues to undergo dramatic change. Much of the change being experienced was precipitated by the passage of a new hospital reimbursement system by Congress in 1983. Under the new law, flat-fee rates were established for 467 categories of Medicare treatment, called “diagnostic-related groups” (DRGs). Under DRGs, hospitals were no longer reimbursed for what they spent, but were given a fixed, predetermined amount per treatment.

In the wake of the new legislation, industry attention shifted to cost-containment methods and the development of alternative modes of health-care delivery not covered by DRGs. Several factors have led to reduced hospital utilization:

1. Enrollment in cost-efficient health maintenance organizations (HMOs) continues to grow.

2. Specialized health-care facilities not covered by DRG fee limitations have flourished, siphoning off patients requiring minor treatment.

3. Hospitals have moved to reduce patients’ average stays to contain costs.

Today, hospitals continue to have problems with over-capacity. Both admissions levels and length of stay have declined over the last decade, meaning less revenue to hospitals. Most hospitals operate at greatly reduced levels of capacity. Many experience heavy losses.

As a result, the industry continues to consolidate. Those hospitals unable to get costs under control either have gone out of business or were bought up by one of the five larger for-profit companies that dominate the industry. Some independent community hospitals are entering into chains or loose affiliations, either nationally or regionally, in order to capitalize on purchasing economies. Some hospitals, especially investor-owned ones, have embarked upon innovative marketing programs to attract consumers. Overall, the costs of operating hospitals continue to increase.

As early as 1987, industry experts were predicting an escalation in competition and a further shakeout among the less efficient and poorly capitalized hospitals. The industry was facing serious worries as competition set in and new liability, management, and financial concerns arose. These essential problems and their solutions continue to challenge hospital management in the 1990s.

MEMORIAL HOSPITAL

Memorial Hospital is a general hospital with 300 beds. There are two larger general hospitals in the city, one of which is owned by Humana, and a fourth hospital, which is smaller than Memorial. Humana, the third largest of the investor-owned national hospital chains, is highly regarded in the industry for its innovative approach to hospital management. Humana recently undertook an advertising program highlighting the quality of its professional staff and extolling the virtues of its patient-care programs to the Bay Village community.

Two years ago, Memorial began an affiliation with the medical school of the local university. It was thought by both boards of trustees that there would be a mutual advantage from such an affiliation. For Memorial, there was prestige to be gained from a university affiliation, and some cost advantages as well. For the university, there were medical resources and a training site.

Since the internship and residency programs are fairly new, they are still being developed and are subject to a certain amount of experimentation. Besides the internship and residency programs, several postsecondary fellows are pursuing further specialization and doing research. Most of the hospital facilities are at their disposal, and in their clinical research, they are permitted to involve the patients in the hospital. Animals are also on site for various kinds of research.

The chiefs of medicine and surgery, and also the pathologists in chief and the radiologist, have joint appointments in the hospital and the medical school. They are therefore full-time, salaried physicians. The joint appointments mean that the medical school pays part of their salaries; and in addition to clinical responsibilities for the hospital patients, they also carry teaching responsibilities in the internship and residency programs. The chief of medicine is also the director of medical education.

Although nurses are not trained in the hospital (since only graduate nurses are employed in nursing services), an active and varied program of in-service education has been developed over the past year and a half. Several members of the medical staff, particularly the chief of medicine and an attending cardiologist, have contributed significantly to designing and executing the in-service education program. Parts of the program use videotaped lecture-demonstrations, which have also been used for nursing education in the other hospitals in the city.

THE PROBLEM

David Chadwick, executive director of Memorial Hospital since January 1983, returned to his office after his summer vacation in August 1992 to find on his desk a letter from Helene Swenson announcing her resignation as director of nursing services.

He was dismayed by the news, for he had not suspected that problems in the hospital could have caused her resignation. He had hired Helene Swenson just over a year before, and she was only beginning to be able to deal effectively with the serious problems that had plagued the nursing organization. In fact, he had expected that definitive and positive changes would become evident by the end of the coming year. He was sure that at that time, the nursing service would take its proper place in the total health-care program.

Chadwick had known for some time that the administration of the hospital had problems that needed careful attention and probably some reorganization. It was with that in mind that he had hired a management consultant earlier that summer. As he returned to work, he was looking forward to the consultant’s help, and he planned to work regularly with the consultant during the coming year.

This resignation by the director of nursing had an immediate effect on his priorities, and he quickly set out to deal with the crisis. Chadwick believed that he had to do everything possible to change Ms. Swenson’s mind. She was too valuable an executive to lose, especially as she had already analyzed the urgent deficiencies in the nursing service. Besides, Chadwick knew that the problems must be serious if they prompted so conscientious a person as Helene Swenson to take this drastic step.

Chadwick phoned Swenson and asked her to come to his office, adding that he was very distressed by her resignation. He suggested an immediate conference, since he was anxious to hear why she was resigning. As Chadwick listened to Swenson’s comments and complaints, he learned more about the nature of the problems in the hospital organization. He realized that his problems were shared by the other executives and especially by his immediate subordinates. He considered most of the people to be experienced and competent. But since the work of each depended heavily on others, he thought a possible source of some of the confusion and ineffectiveness lay somewhere in the relations among the executives.

Chadwick asked Swenson to withdraw her resignation and to wait until the situation could be analyzed more carefully He promised that in the meantime he would investigate the specific issues she had raised, discussing with the persons immediately involved, those that had led to her resignation. She made it very clear that these problems impeded her work to the point where she alone could no longer deal with them. Chadwick decided he had to mediate between Swenson and several other members of the administrative group to find workable solutions.

On a more general level, Chadwick decided to undertake, with the consultant’s help, a thorough analysis of hospital organization, including various individual responsibilities. The consultant agreed with Chadwick that the understanding that might result would be very helpful in reaching a long-term solution.

Actually, this work had begun early that summer when Chadwick had hired the consultant to examine the entire organization of the hospital, including nursing services but excluding the medical organization. He had spent considerable time with the consultant in clarifying his own role as executive director. They had begun by examining his relation with the board of trustees, specifically his relation and work with the various committees of the board. Then they had examined his working relations with other executives in administration and physicians who headed the main medical departments of the hospital.

Chadwick felt confident that he had the support of the board of directors in his efforts to modernize and upgrade the quality of care being given at Memorial Hospital. The board had worked closely with him in arranging the affiliation with the university. He had received three superb performance evaluations and expected another at the end of the year—provided he could find a solution to the problems in the administration that seemed to be indicated by Ms. Swenson’s sudden resignation.

As a result of the news of Helene Swenson’s resignation, Chadwick wanted to shift the emphasis of the consultant’s work to a close examination of the work of his subordinates and their relations with each other. As a first step in that direction, he suggested to Swenson that she and the consultant should spend as much time as necessary to pinpoint the problem she had so as to get the analysis under way.

THE “LEPER COLONY”

Chadwick had hired Helene Swenson as director of nursing services after firing the aged incumbent he had inherited from his predecessor. Swenson had held a similar job in another hospital, having begun her career in nursing administration first as supervisor of operating rooms and later as associate director of nursing at a large teaching hospital in a neighboring city.

On assuming her position at Memorial Hospital, Swenson discovered that the situation in its nursing services was worse than she had been led to believe. Not only was there a serious shortage of nurses, but only a handful were competent. Worse still, she found is was nearly impossible to recruit more personnel, since the hospital had the reputation of being an undesirable place to work. She had once remarked, “From the way people react to my recruiting overtures, you would have thought we were running a leper colony!”

Nursing standards were among the lowest she had ever seen. “I would be very reluctant to advise any sick person to come here as a patient, and you can appreciate what it means to me to have to say that. Except for one or two nurses and two of the supervisors, professional discipline and responsibility barely existed. Nurses simply disappeared off the floor for varying periods and the patients were left unattended.”

There were no educational activities in operation, so there were no attempts to introduce innovations in nursing practice and no way to keep nurses posted on the developments of clinical practice. There was a running feud between most of the nurses and the attending physicians, and mutual hostility and mistrust with members of the house medical staff. In short, Helene Swenson had found precious little that would attract new nurses to the hospital.

The daily routines included an overwhelming amount of paperwork. There were forms to be filled out for every administrative department of the hospital, from personnel to accounting. Yet, despite the time invested in filling out forms and submitting them to administrative offices, Ms. Swenson had difficulty gaining access to even the minimal amount of information to plan the work load and use her scarce nursing staff’s time most effectively. Work schedules for day, afternoon, and night shifts never seemed to match the demands of those shifts.

Although a new system for payment had been installed at the time she joined the hospital, she had never seen it operate satisfactorily. Every week there were discrepancies between the payment people received and what they felt it had been agreed they would receive.

She had, after more than a year of great effort, reached a point at which she felt that some headway had been made in her own area. Still, she was far from satisfied with the help she got from her colleagues. Several serious clashes with the director of personnel finally precipitated her decision to resign.

In view of Chadwick’s promise to actively try to solve the problems that she felt needed intensive and immediate attention, Helene Swenson was persuaded to stay. But she cautioned, “I cannot go on doing the work that I think needs to be done around here unless something changes. I must know what I have the right to expect from Frank Samuels [the director of personnel] and Michael Ryan [the associate director], and I must have some assurance that it will be done.

I must also know and understand what they want me to do and what they have the right to ask me to do. After all, if we all know what our jobs are and how our jobs coordinate, we all can concentrate on our own work and stop devoting our energies to working against one another and constantly having to call on Mr. Chadwick to mediate our differences.”

A SERIES OF COMPLAINTS

Helene Swenson discussed the situation in several sessions with the consultant and now and then with Chadwick. Referring to the organization chart (Exhibit PC–1), she said, “I have studied it for hours trying to figure out what it means in terms of my relationship with some of these people. But it tells me very little, except that I am responsible for a certain number of units in the hospital and that Mike [Ryan] is to run such sections as admitting, central supply, and the pharmacy. We don’t actually have an assistant director yet, though a new person is supposed to join us in a couple of weeks.

“Each time we have any problems with these activities, I can complain my head off to Michael. But as often as not, he continues to do what he wants and disregards what I tell him. Or he tells me that things are going wrong because somebody in my area is inefficient. In the end, because he clearly ignores some of the things that I tell him, I must complain to the boss. I wish I didn’t have to, but I do.”

Helene Swenson admitted that if Michael Ryan were to suggest that she alter some part of her organization and she disagreed with him, she would also refuse to follow his suggestions. The only way in which the work in nursing and the work in the pharmacy, for instance, could be coordinated was for her and Michael and the chief pharmacist to go together to Chadwick. They always seemed to be able to iron things out that way.

Just recently, a disagreement had arisen about some changes in running the pharmacy. The manner in which orders for medicine was passed from hand to hand and transcribed had caused several serious errors. While physicians waited for medicine to be given to a patient, the nurses would be transcribing the orders onto a requisition to the pharmacy. After filling the order, the pharmacist would post the drugs on a daily tally sheet to produce a daily list showing all the medicines that had been dispensed to hospital patients. This sheet would then go to the business office to be charged to the patient’s bill. Besides creating errors in transcription, the method required time in nursing, pharmacy, and the business office.

Helene Swenson and the chief pharmacist had met and had worked out a simple system to avoid all this. The new method was obviously an improvement, and both she and the chief pharmacist couldn’t understand Ryan’s objections. The doctor would henceforth write the order onto a form with several copies. One copy would go to the pharmacy as a requisition; another would go directly to the business office; and the other copies would be used in the nursing station for the patients’ records and as nursing instructions so that the nurses could administer the medicine when it arrived from the pharmacy.

For some reason, Ryan objected. Only when Swenson and the chief pharmacist presented the plan to Chadwick and he endorsed it enthusiastically did Ryan agree to the change. “And it works beautifully!” Swenson told the consultant.

In Ryan’s favor, however, she said she had gladly accepted his advice on budget procedures. Since he was well versed in how to set up departmental budgets, she had done exactly as he had told her. Ryan had to coordinate many of the day-to-day operations, including many medical aspects such as the various laboratories, X-ray, the emergency unit, and the outpatient department. His suggestions for coordinating work among these medical and paramedical units and nursing were accepted by almost everyone, including the physicians in chief and Helene Swenson. He seemed to have a comprehensive view of the way these activities meshed. And since none of the individuals, such as the chief pathologist, the physician in chief in medicine, and Helene Swenson, knew the details of the operations outside their own departments, it was Ryan who moved from one to the other and suggested ways of getting more efficient interaction toward the outcome, namely patient care.

“You know,” said Swenson, “I don’t understand the situation with Mike. When he is making suggestions to all of us, such as when the patient-care committee was trying to coordinate the work of the chemical laboratory, the outpatient department, and my nursing people, he is straightforward and decisive. But the moment I try to work with him on some coordination problem that involves one of his departments, like admitting, pharmacy, or dietary, he seems hesitant and evasive. Even when he promises to straighten things out, like the tie-ups in getting materials out of central supply, he never seems to take the promised action.”

Swenson recalled one issue that had lingered unresolved for several months. It involved the dietary department, the admitting office, and nursing. The problem was that many hours passed after a new patient was admitted before the dietary department supplied a meal for the patient. The nurses on the ward were upset at this delay, because it prevented them from offering some small gesture of welcome and hospitality to the new patient. First the nurses complained to the dieticians, but the dieticians passed the blame to the admitting office, and the admitting office offered the explanation that the attending physicians often neglected to specify diets for their patients. Without any instructions from a physician, there was no request to the dietary department to supply a meal.

For weeks Swenson asked Ryan to take some action to coordinate the work of the doctors, admitting, and dietary so that these delays could be eliminated. But despite his assurances and promises, more time passed with nothing done. In her view, Ryan should have specified some policy to admitting and dietary that would guide them if a physician’s order was not immediately available. “Certainly tea and a piece of toast couldn’t hurt anyone. And it would be a way of saying to the patient that he or she was being cared for and welcomed.” Swenson said that most of the time the nurses themselves decided to order something from the kitchen and give it to the patients. But the head of dietary was against this kind of action, claiming that it brought risk to the hospital. She had to have doctors’ orders before any food was administered to a patient. The nurses, however, had developed relationships with some of the kitchen servers, who understood the problems the nurses were having with the delays in getting food to new patients and who were usually willing to allow the nurses to order something for them.

Regarding the outpatient department, Swenson was frankly at a loss about her responsibilities there. The supervisor of the department was a nurse subordinate of Swenson’s. But Chadwick had said that although Swenson was accountable for the nursing service in the outpatient department, Ryan was responsible for “everything else.” Swenson’s attempts to get Chadwick to clarify this statement had so far been unsuccessful. She had the impression that responsibility for the outpatient department moved back and forth between her and Ryan. Although it was clear that Ryan had to coordinate the role of the physicians with nursing and paramedical services, and that this involved difficult problems of scheduling, Chadwick had not made it clear to her in what way the outpatient department was different from other nursing wards, for which she was totally responsible.

Swenson told the consultant that apart from these particular problems that she had cited as difficulties with Michael Ryan, she was really much more concerned with trying to understand what her attitude toward him should be. She clearly recognized Chadwick as her boss. It was he who decided with her what her main objectives were, and certainly he was the one who provided her with the resources she needed to get her job done. Furthermore, because of the importance of the nursing service to any hospital, she knew that reestablishing efficient and effective nursing services was a primary consideration for the hospital. Therefore, within reason, she could get almost anything she asked for from Chadwick. True, the two of them sometimes differed about the priorities of means and ways of accomplishing main objectives. Some of the time he would get his way, and some of the time she would get hers.

When it came to Ryan, however, she felt that on certain matters his advice seemed to lack authority. She accepted his ideas and felt they were generally helpful to her and to others when the issue was clearly within an area of his expertise or when it concerned the coordination of work across the various hospital departments, but she was less inclined to accept his views when one of his own departments was involved. And why did he back off and become indecisive when just the two of them tried to iron out their common difficulties? Swenson said that when they both went to Chadwick to iron out their differences, “Mike often ‘chickens out’ on me when the problem involves his departments. In the presence of the boss, he just fails to state his views openly and leaves me to stick my own neck out. I guess that’s his way of looking good.”

THE MAKING OF THE CRISIS

As the discussions between Helene Swenson and the consultant proceeded over several weeks, she described and explained her relationship with the director of personnel, Frank Samuels, and how it was problems in that relationship that had led to her resignation.

Frank Samuels had joined the hospital several months after she did. At the time, she had looked forward to working closely with him. Since one of the most critical problems in nursing was human resources, or rather the lack of them, she had hoped to receive much needed help from Frank. “But it was my expectation that I would call the shots. I felt that I was entitled to ask for help from Frank. I didn’t expect that his help would be thrust on me in accordance with his judgments of what I needed.”

Very few months had passed before Frank Samuels realized, from discussions with Swenson, that recruiting nurses was a top priority. He decided that one of his most important tasks as director of personnel should be a recruiting trip through the Southeastern states. Samuels recommended the project to Chadwick and succeeded in convincing him that one of the senior supervisors should accompany him on that trip.

Swenson had opposed the idea, but since she had not had time to plan her own recruiting strategy and had no alternatives to offer, Samuels was authorized to take the trip. “I felt it was absolutely wrong, but I didn’t know exactly why. I wish I could have been more convincing in opposing the project, because I knew it would not work.”

This expensive trip produced only one recruit, who turned out to be unsuitable after Swenson interviewed her and checked her references. If this had been only her opinion, she would have admitted that she might have been all too ready to turn down this find because of her opposition to the whole recruitment approach. But since she needed nurses very urgently, she asked one of her colleagues at a neighboring hospital to do some reference checking for her. What Swenson learned confirmed her own judgment and information.

She began to understand better the underlying reasons for her disapproval of Samuels’s trip after she began getting some feedback from people in her profession in those colleges and hospitals that Samuels and the supervisor had visited. There were certain traditional rules to be observed when nurses were to be recruited. Educators in nursing and nurses themselves wanted to talk to members of their own profession. Samuels did not know enough about what went on in nursing services at Memorial Hospital; he didn’t know where the existing personnel had been trained; and he did not know enough about the subtleties of nurse-doctor relations in the hospital to discuss these matters. Also, the fact that he was a male recruiter in a predominantly female profession was not in his favor.

“Frank just had no idea how to deal with nurses. He also had no way of knowing what were the peculiar requirements of the nursing services in this hospital. And he did not realize how bad our reputation was because he could not read between the lines of the many refusals he got. Frank could not offer any nurse the kind of inducements that might have brought her here as a challenge, because he doesn’t know what might challenge today’s bright young nurse. And taking a very elderly supervisor along certainly did not do our image any good whatsoever. She didn’t truly represent our group.”

For a while this trip and its failures greatly annoyed Helene Swenson, especially because her own reputation suffered from it. It took quite some time until the word got around why she herself had not done the recruiting. After his failed trip, Frank Samuels was excluded by Chadwick from recruiting nurses.

Swenson told Samuels that she would greatly welcome his contribution to devising and implementing a payment plan that would provide fair remuneration and make possible simple and easy calculations of pay for both nurses and non-nursing personnel. She had hoped this would eliminate the cumbersome and error-ridden situation she had inherited.

Also, she desperately needed a way to maintain up-to-date information on nurse staffing patterns and schedules. She asked Frank to look into her particular needs in the nursing services and advise her on a scheduling system she might adopt.

At about the same time, Chadwick asked Samuels to compile an employee handbook that would describe clearly and attractively the whole range of working conditions, pay, and benefits applicable to all employees of the hospital.

Swenson expected that Frank Samuels would complete this handbook as quickly as possible, for it was essential to her in her own recruiting program. But the deadlines she planned on passed several times. So she decided to put a handbook together on her own for exclusive use in nursing. However, when it was done, Chadwick reprimanded her for doing so. Although he also was exasperated by Samuels’s procrastination, he considered it essential that Samuels be the one who put the handbook together. After all, it would be a policy document for the whole hospital, committing the entire institution to an internally consistent and equitable system. It could not be oriented to any particular segment of the hospitals employees.

Swenson reacted with anger and frustration. She was frustrated because she had expected Samuels to meet her time targets, although she had never spelled them out. She was angry⁷ because her independent but necessary action had brought Chadwick’s disapproval on her. So although in the early months of working side by side in the hospital she had often sought Samuels’s advice, her disappointment with his ineffectiveness in meeting her needs turned into hostility and mistrust. Gradually, the two increasingly avoided each other.

Besides the expectations Swenson had regarding the handbook, Samuels’s advice on systems of staffing control, and a clear scheme for payment, she had other expectations of cooperation and help from Samuels that had not materialized. For instance, she asked that one of his subordinates recruit and preselect clerks, secretaries, and nurses’ aides. When these tasks were not done, Samuels responded to her queries by claiming that his people had no time for them. Also, he turned down her many requisitions for personnel with the explanation that they were not included in her budget.

Her feelings were aggravated by Samuels’s instructions to her and to her staff. She felt that these instructions interfered in what she felt were her decisions. For example, she cited his interference in the decisions on selection and termination made by her and several other people in the administrative group. Samuels had made a big issue out of her decision to hire a secretary whom he had fired from his department. Although she finally gave in, she did not understand his stubbornness in opposing her on this matter.

Some months before the incident of the secretary, she had decided to add to her own administrative staff a personnel assistant who had worked for Samuels and whom he had fired. Swenson hoped that with the help of a person experienced in the personnel policies and procedures of the hospital, she could overcome some of the problems of the excessive work load. Particularly when the help she wanted had not been forthcoming from Samuels, as she hoped it would, she decided to provide herself with her own “personnel resource person.” Assuming that the dismissal of this young woman by Samuels had derived largely from a personality clash between them, she expected that a change in bosses would have a positive effect on the young woman. At any rate, at that time Samuels raised no objection to the transfer. She therefore assumed that he would not oppose her decision to hire his ex-secretary.

“I wish Frank would stop his continuous interference in our personnel procedures. On a few occasions, Frank came after us when we revised a few job descriptions of non-nursing positions and rerated these positions. After all, it is my decision to change the work of a secretary, clerk, or assistant in our nursing education program. I do so because I see the need for such a change. Once or twice the change may be the result of a recommendation one of the nursing supervisors or my associate director makes. What Frank fails to see is that jobs aren’t a sacrosanct, fixed, unchanging series of tasks. New things have to be done all the time! And when I decide that we are going to do other things, new things, and I want them done the best way possible, I am going to assign them to the best person I have in my organization. Naturally, when I do this, that person is going to have more responsibilities. And when I see after a while that the person is getting these things done well, I want to rerate the job. It simply isn’t the same job. So by what right does Frank tell me this job is worth $1,500 a month when I think it’s worth $1,650 a month? All I did was move it up one grade. I am not violating the whole grading system, which he set up. I am only using my judgment. And my judgment tells me that the way I have changed the job content means it is a higher-level job!”

Samuels was continually sending back pay raises for nursing personnel that Swenson had approved. Each time these rejections were accompanied by the statement that the raise exceeded that authorized by the payment system. If she decided on a raise of a certain size, she was not going to be told by him that is was not authorized. After all, contended Swenson, she and she alone was going to answer to Chadwick for the way in which she was using the resources he had put at her disposal.

The final straw came just as she was in the midst of the busiest period of the interviewing season. Members of her staff, including her associate director, had spent time that they didn’t have putting the handbook together in anticipation of applications from newly graduated nurses following an intensive recruiting campaign. There was a backlog of work all around, and it was compounded by an inability to straighten out the continuous errors in the calculation of pay rates as they were returned from the personnel office. As these discrepancies between calculations from personnel and those done in her own department continued, Swenson became even more convinced that the procedures for payment were unclear and conflicting and that the calculations were too time consuming and subject to error.

She had to do something about this. The exasperation of her administrative staff affected her as well, and she went to Samuels and asked him once and for all to untangle this mess. His response was that no other department in the hospital except nursing had any difficulties with the pay rates and the calculation of individual salaries. He just did not know whether there was any point in repeating his explanation for the umpteenth time. That response, along with his persistent imposition on the time of her administrative staff and supervisors by his demands for information about the nursing complement and other statistical information, triggered her submission of a letter of resignation.

HER OTHER COLLEAGUES

Even taking their different personalities into account, Helene Swenson still wondered why she had more trouble with Samuels and Ryan than with the controller, Robert Wilkins, and the administrative engineer, Joseph Gelardi. Both these men, each in his own sphere, had always been extremely helpful to her.

As she increasingly avoided contact with Frank Samuels, Swenson turned to her other colleagues, particularly to Robert Wilkins. She solicited Wilkins s help for clarification of the payment system, thinking that since he issued the payroll checks, he would understand the system. Yet the discrepancies persisted.

On several occasions she also turned to Ryan for advice on matters that were clearly in Samuels’s domain. He did not turn her down, but in trying to please her, he came into direct conflict with Samuels. Just recently, when Chadwick learned that Ryan had advised her one way while Samuels had advised her another way, Chadwick severely reprimanded Ryan for making a decision that was not his to make.

Although Gelardi did not exactly perform miracles when Swenson asked him to make some complicated alterations in one of her nursing stations, at least he completed the work within a reasonable time frame. Some of his suggestions were so helpful that the occasional delays in getting the big jobs done were forgiven by the nurses at the station and by Swenson herself. She expressed relief that Gelardi was at least one of two people she could rely on to get things done so as to facilitate her own work.

As for Wilkins, he had been very cooperative in accepting the changes in the system for requisitioning and issuing medicines that she and the chief pharmacist had worked on.

Wilkins also needed information from the nursing service to enable him to produce the monthly reports to the administrative groups and to the board of trustees. But once he had established the frequency and format of the information he wanted from Swenson and her staff, the reporting became routine, and Swenson did not feel that Robert’s demand for periodic information from nursing was in any way an imposition. This situation, she thought, was in considerable contrast to the degree and extent to which Samuels imposed on her and her staff. However, she was at a loss to explain the difference, except that she had the impression that the sheer quantity of information that Samuels demanded was greater. Perhaps, she conceded, it was also harder to gather because the system was unclear.

Swenson hoped that Chadwick’s reassurances would bring with them the beginnings of a resolution of the problems she had been battling not very successfully. She had every reason to rely on his promise to clear up the relationship with Frank Samuels in particular. She doubted that the two of them could start from scratch. But at least they could eliminate this continuous friction. She expected that if the irritations and obstacles in her relations with some of her colleagues could be mitigated through the concentrated communication and analysis afforded by the consultant, and if Chadwick could see himself and the organization with greater clarity, there would be clearer sailing over the next eight to ten months. By that time, she was sure, the results of her efforts to develop better services would demonstrate that her decisions had produced satisfactory results, or, as Swenson herself put it, “Mr. Chadwick can have my head.”

REVIEW QUESTIONS

Write the consultant’s report on Memorial Hospital. Your report should include:

1. An evaluation of the planning process at Memorial Hospital.

2. An assessment of the organization and staffing decisions.

3. An analysis of the leadership style demonstrated by Chadwick and its effectiveness in motivating his employees.

4. An assessment of existing systems and some recommendations for areas that need improvement.