The Practice Case Solution

In a complex situation such as this, there is no textbook solution. The number of variables precludes such an approach. The maturity and insightfulness of the consultant will be an important factor in approaching the assignment. The objective is to teach the student the value of looking beyond symptoms to the underlying causes of problems and then searching for approaches that will deal with those underlying causes and, in so doing, result in actions that will preclude their reoccurrence.

There are two keys to being a successful manager: the ability to define problems objectively and the ability to implement changes that will preclude them from future consideration. Being able to accept criticism and to realize the tolerance levels of others for criticism as they seek improvement is helpful in overcoming resistance to needed change.

The following suggested solution is offered primarily as a guide for the student to see how well he or she evaluated the overall situation. In doing this, similarities to real-life situations will become apparent. The intent is to stress comprehensiveness and thoroughness in the development of recommendations designed to improve individual performance and the total organization.

THE CONSULTANT’S MEMORANDUM

Chadwick’s consultant, having studied the situation for most of the summer and having had conversations with everyone in the case, delivered the following memorandum to David Chadwick and his top managers.

After several months of intensive discussions with you, both individually and in small groups, it is time to summarize in writing some of our conclusions.

Two principal organizational problems have been at the root of the situation with which you have had to contend.

First, Mr. Chadwick, who is your common “boss,” has for a long time been reticent to intervene directly in your work. I believe that it is fair to say that this reticence is due partly to his insufficient understanding of what each of you does, and partly to underestimating the importance of leadership in an organization that depends on many people to do different jobs simultaneously and sequentially.

Much of the time the absence of directive leadership has inhibited some of you from making decisions on your own. The progress of your respective tasks has thus been less effective and timely than it could have been. Some of you have been very hesitant because you do not know which decisions and actions are up to you. On the other hand, when you have acted, you have sometimes been slapped down for dealing with matters that turned out to be outside the limits of your responsibilities.

Mr. Chadwick has been very successful in his relations with the board of trustees. He has planned and implemented an affiliation for the hospital with the local university, which promises to bring long-term benefits to Memorial in the form of better public relations and some cost advantages in shared resources. However, his energies have been consumed in formulating these plans and managing the external arrangements to the extent that he has neglected to examine the implications for his own staff. He has been remiss in not thinking through some of the necessary coordination that must occur between the medical staff (doctors, interns, and so forth) and the hospital staff. He has set forth general objectives for the hospital, particularly the objective to improve the quality of care given to patients. But these objectives have not easily translated into operating plans.

The operations of the hospital have been characterized by an overabundance of paperwork and procedures. Attempts to simplify procedures (such as medication ordering) have not been encouraged. As a result, procedures have rarely been simplified.

Mr. Chadwick has not effectively communicated his overall objectives for the hospital so that each of his administrators would have a clear idea of how their particular unit(s) contributed to meeting these goals.

Mr. Chadwick’s priorities in allocating financial resources have stemmed from his determination to see Memorial Hospital become a financially viable and reputable health-care facility. Had some of you been made explicitly aware, for example, of Mr. Chadwick’s priorities in allocating the hospital’s resources over the last year, you would not have interpreted Ms. Swenson’s actions as you did. She is not favored with limitless power to do as she pleases. But rather, in order to achieve even marginal improvements in nursing services–an area of operations vital to the hospital–Mr. Chadwick made available to her a disproportionate part of the hospital’s resources. This explains why Ms. Swenson was at times permitted to depart from the existing payment scheme, and why she was authorized to hire additional people when no other department manager was provided with the resources to do so.

Mr. Ryan, in particular, because of the many occasions on which he is deputy for Mr. Chadwick, proceeded very cautiously on a number of issues affecting the interrelationship between his operations and those of Ms. Swenson. Only trial and error revealed to him which decisions he was free to make on his own, and understandably he had tried to minimize the errors. He was not sure often enough when he had Mr. Chadwick’s backing and when he didn’t. Clearer direction from Mr. Chadwick might have enabled Mr. Ryan to have greater certainty about this backing.

At the same time, Ms. Swenson, pressed for resolutions that would serve to facilitate the attainment of her goals, was reluctant to accept from a colleague an instruction that seemed different from what she deduced to be Mr. Chadwick’s intent.

In our individual discussions, many other examples reflecting the absence of clear direction from the top were discussed. Some of this, as you know, is being rectified by Mr. Chadwick and each one of you in the effort to establish priorities, goals, and objectives that are explicitly and mutually agreeable.

The second problem is an organizational one, which has implications for control systems in the hospital. Some of you fill mixed roles that are not clearly delineated on an organizational chart, but that are often critical to the administration of hospital services.

Mr. Ryan and Mr. Samuels, in particular, are not directly responsible for the administration of patient care, but they have responsibilities that require coordinating departments that do have direct line responsibilities. This sometimes causes confusion about duties and authority among you. Mr. Samuels, for example, must be responsible for overall hospital personnel services. He must ensure that there are no contradictions and inconsistencies in the way hospital personnel are hired, paid, and evaluated. At the same time, he must be able to delegate to the line personnel the responsibility to manage the entire human resource cycle. We have seen that he cannot adequately implement the operating plans for staffing on behalf of Ms. Swenson, no matter how good his intentions.

Lastly, enclosed is the organization chart we developed as a result of our discussions [Exhibit PC–2]. It still may not be the ideal or most effective way to organize your executive roles or divide the work that needs to be done in the hospital, but at least it reflects more realistically the situation as it exists now.

I look forward to further work with you.