Step 2 Grading Rubric EconomyTask descriptionComponents of .docx

Step 2 Grading Rubric: Economy
Task description
Components of the task
Total points
Major economic features
Current demographic and economic features:
What is the population of your country, its age and gender
composition? (2 points)
What are the major natural resources and the major features of
the economy? Is the economy driven by the export of minerals
and raw materials, agriculture, significant industries, or a
mixture of these? What are the main exports and imports? (5
points)
Which countries are its largest trading partners? Is the country a
member of regional or continental African trading blocs? (3
points)
What are major livelihood strategies, formal and informal, in
both rural and urban settings? In other words, how do people in
your country make a living? (5 points)

15
Economic policies
How did colonial policies impact your country’s current
economic conditions? (5 points)
How has domestic economic policy since independence shaped
the country? (5 points)
How have international economic forces shaped your country’s
economy? For example, has your country been impacted by
World Bank or International Monetary Fund programs? Do
international trade agreements impact your country? (5 points)
15
Basic economic conditions
What is the current Gross Domestic Product (GDP) and Gross
National Product (GNP)? What is the significance of these
numbers for the economy of this country? (3 points)
What is the unemployment rate? (I point)
What is the poverty rate? (I point)
What is the foreign debt? (I point)
What do all these different economic indicators show about the
state of the economy in your country? (3 points)

9
Technology
To what extent are the Internet and mobile phones, including
the mobile banking system, used in your country? Do these
affect economic potential and how so? (4 points)
4
Conclusion
Using all the data and analysis you have done pertaining to the
above questions, write a conclusion addressing the economic
health of your country and analyze the main factors contributing
to its current strengths and challenges. (3 points)
3
Other requirements
Referencing:Evidential Proof of sources used: Papershould be
supported by evidence and quotations from sources. At least
three sources with APA citation at the bottom of the report,
Variation in selection of sources necessary (2 points). Full
points for accurate use of APA in-text and reference list)
Organization of text: Well organized, detailed and
logical/cohesive arguments addressing relevant issues.(2 points)

4
CASE 6
From Nothing to Something: Defining Governance and
Infrastructure in a Small Medical Practice
Dea Robinson
Midtown Neurology was started by a single physician who had
been practicing in the community for nearly 20 years. As the
practice grew, it evolved from a “mom-n-pop” operation to a
more complex model. The founding physician recruited four
new neurologists to join and continue to help build the practice.
Subsequently, however, the new doctors took over and forced
him out of the practice.
The large urban hospital with which Midtown was affiliated
achieved Level 1 trauma status, providing additional new
opportunities for the practice. The neurologists took on the
many responsibilities, including one of stroke team for the
hospital. Contractual rural outreach was practiced utilizing
telemedicine throughout the state and provided a robust revenue
stream.
While still a small physician group, it required a difficult call
schedule. Tracking call and distributing it equitably became a
challenge. The main reason for this was the founding physician
had written a proprietary program exclusively for this purpose.
Now the practice was beholden to the very person they
had forced out of the practice for a vital part of communication
with the other practices regarding the call schedule. This was
very unusual, as physicians don’t typically write proprietary

software for a practice. In addition, the entire platform
including the billing program, which he also developed, used
MS-DOS.
The practice employed a practice manager who had started with
the founding physician. As the practice grew, the manager did
not keep up with the basics of managing a practice. Her
information relating to billing, reimbursement, and changes to
current CPT and ICD-9 issues was out of date. She was also
ignorant of the contracts the practice had, but more
importantly the impact of those contracts on the practice and
how to carry them out appropriately.
While the physicians were very productive, several significant
management problems became apparent as the practice grew. In
particular, the infrastructure suffered and there was no
governance. Infrastructure for a private practice is different
from that of a corporate model. For example, in a corporate
model individual departments exist with defined responsibilities
to support the needs of the corporation and other areas of the
entity, such as an IT department. Conversely, in a private
practice when IT systems need repair, the responsibility falls to
the administrator or manager, and this individual must know
how to address and fix the problem. In this instance, the IT
department and the owner of the practice were one and the
same. Because of the proprietary nature of the software,
outsourcing was not an option. The practice essentially was
backed into a corner because of the lack of necessary
infrastructure upgrades, such as in the case of IT. This dynamic
created tension and frustration for the manager of the practice
and the employees. The situation did not allow management to
function normally in some instances.
The governance structure of the group required change after the
solo physician hired the new neurologists. The new physicians
had a more contemporary view of what a practice should look
like and how it should function. This concern was the basis of
many governance and trust problems. The IT and billing
systems were grossly outdated, but the founding physician had

taken great pride in his proprietary abilities and had not allowed
changes. This attitude was prevalent in nearly every decision
made, from what referring physicians the group would associate
with to choices of staff. When decisions needed to be made,
there was not a single voice for the practice, and this created
confusion for the hospital and other referring colleagues. The
group was resistant to appointing anyone as president and this
habit had continued after the founding physician was forced out.
The physicians did not particularly like or trust each other. No
one wanted anyone to become the practice leader or be the voice
of the practice when building relationships with referring
physicians. Each physician wanted to have his or her own
individual PC and to run different revenue streams through the
practice. All were secretive about their side deals. Employment
contracts were never created and thus potential partner
arrangements or what constituted partnership did not exist.
Policies, procedures, and basic business documents, such as an
employment manual for the staff, were never written or
implemented.
Having access to neurological consultations on a 24/7 basis is a
huge benefit for a Level 1 trauma hospital. The group was able
to fulfill the need for the hospital; however, the outpatient piece
of the practice suffered. Therefore, the hospital recruited three
other physicians for the group to take over the out-patient
portion of the practice. Due to the unstable relationship of the
current physicians in the group, all three of these physicians
subsequently left the practice, leaving the responsibility of
finding replacements with the remaining physicians.
A requirement for smooth governance is the ability of the
physicians, staff, and managers to trust each other. As the
relatively new administrator of the practice you have come to
realize that one of your first challenges is to bring the
importance of governance to the attention of these physicians.
You will also need to educate the physicians on the
consequences of “going off on their own” and making
arrangements on the side.

Discussion Questions
1. What are three organizational issues going on in this case?
Which organizational theories do you think apply best to this
situation?
2. Make a list of things you need to do as the new
administrator and prioritize them. Provide a rationale for your
list and priorities.
3. How would you gain the trust of the individual physicians
in light of the fact they do not trust anyone on the staff?
4. What specific management strategies would you work to
put in place?
5. How would you engage the staff to help the infrastructure
gain strength?
6. What processes and dynamics need to be in place before
starting the process of recruiting new physicians to work in the
practice?
7. What objectives for success could you use in determining if
governance was going in a better direction?
8. Can you see consequences to patient care with a fractured
group? Explain why.
ADDITIONAL RESOURCES
Borkowski, N. (2011). Organizational behavior in health
care (2nd ed.). Sudbury, MA: Jones and Bartlett.
Buchbinder, S. B., & Shanks, N. H. (2012). Introduction to
health care management (2nd ed.). Burlington, MA: Jones &
Bartlett.
Hayes, D. F. (2008). Starting a medical practice 101:
Governance. Orchard Park, NY: Byzan Med, LLC. Retrieved
from http://www.businessandmedicine.com/essays/governance.p
df
Healthcare Strategy Group. (2009). Governance models that
work. Physician Strategy News. Louisville, KY: Healthcare
Strategy Group. Retrieved
from http://www.healthcarestrategygroup.com/newsletters/articl
e.php?show=governance_models_that_work
Stearns, T. H. (1999). How physician/administrator teams work

in small groups: Six steps to make it happen. Medical Group
Management Journal, 46(3): 44–48, 50.
Zinober, J. W. (1991). A physician’s guide to practice
governance. Medical Group Management Journal, 38(2): 54–56,
59–60.
CASE 8
Governing Board vs. Management
Louis Rubino
Lakeview Hospital Medical Center is a for-profit 250-bed
hospital in a small but growing community that is rich with
large internet businesses. The governing Board has recently
been overhauled with about half being returning members and
the other half being newly appointed. In an effort to have more
“outsiders” on the Board of Directors (those who have no
financial ties to the hospital), the longtime Chairman of the
Board, Rick Brennan, and hospital CEO Marsha Choy scoured
the surrounding area for experts in certain competencies who
could enrich the Board deliberations. They found and
recommended an attorney familiar with health care insurance
laws, a professor from the state university who used to be a
hospital system corporate executive, a local politician who is
pushing for implementing policy in the community to improve
individual health behaviors, and a former patient who is quite
vocal about improving the health services at the hospital.
During the orientation for the new Board members, Rick and
Marsha were very careful to address the fiduciary responsibility
placed on the Board of Directors. They emphasized how the
Board is to set the mission and vision of the hospital and
develop matching strategies to propel the organization into the
future. The new Board members are very enthusiastic and show
great interest in advancing the hospital especially as health care
reform takes hold. During the orientation, though, Marsha made
a presentation that showed the various performance measures
for the hospital, many of which are readily available to the
public on the internet. The Board members are very dismayed to
see how Lakeview falls below the other competing hospitals in

their community, even the public safety-net facility. The new
Board members pledge that this will not continue under their
“watch.” Rick and Marsha start to get nervous about how much
involvement the new Board members will have in the operations
of the hospital.
During the Board meetings, it is clear that there is a big
difference between the new and old Board members. The more
senior Board members are reading their reports and making
comments but then defer to management on handling the
implementation and monitoring of the issues being addressed.
The newer Board members feel that they need to get more
actively involved to assure change is occurring. The Board
members read from one of their ongoing educational pieces on
health care trends about executive rounding. They decided that
each Board member should visit a particular area of the hospital
every month and report back at the Board meetings on the staff
and patient responses to their inquiries.
The staff is enjoying meeting the new Board members as they
make rounds and are not shy about telling them all the things
they think are wrong with the management of the hospital. The
newer Board members are concerned over the remarks and urge
Rick and Marsha to address these issues at the Board meetings.
They try to accommodate the request but now the Board
meetings are running over four hours long and becoming more
focused on daily management than on strategy formulation.
Communication is being altered on many levels. The
communication between the Board of Directors and management
of the hospital has changed from emphasizing being equal
partners in the improvement of the hospital to being more
hierarchical with management having to provide explanations
on the issues raised due to the Board rounds. The more senior
Board members are frustrated with the shift in their meetings
and are starting to be silent during the discussion on these
issues and are developing a pattern of leaving the meetings
early. The administrative team is telling the employees not to
engage the Board members in any discussion that could get

them in trouble. And worst of all, improvements have not been
demonstrated in the latest public reports.
1. Do you feel it is appropriate for Board members to be
making executive rounds in the hospital? If so, should they alter
how they are responding to the issues they are hearing about?
2. What role should Rick take on as he tries to address this
transformation of the Board’s involvement into operations.
What about Marsha’s role?
3. How should the agenda of the Board meeting be changed to
perhaps review the issues being raised yet not prolong the
length of the meeting?
4. Are there other ways the new Board members can be
engaged in the improvement process that might not be viewed as
taking over management of the hospital?
Belmont, E., Haltom, C. C., Hastings, D. A., Homchick, R. G.,
Morris, L., Taitsman, J., Peisert, K. C. (2011). A new quality
compass: Hospital boards’ increased role under the Affordable
Care Act. Health Affairs, 30(7), 1282–1289.
Buchbinder, S. B., & Shanks, N. H. (Eds). (2012). Introduction
to health care management (2nd ed.). Burlington, MA: Jones &
Bartlett.
Studer, Q. (2008). Results that last. Hoboken, NJ: John Wiley &
Sons.
White, K. R., & Griffith, J. R. (2010). The well-managed
healthcare organization (7th ed.). Chicago, IL: Health
Administration Press.
CASE 9
Transitioning to a New Leader
Louis Rubino
The Surgery Department at St. Gerard, a major academic
medical center, is in the midst of change. New leadership has
been appointed, which is rapidly changing the culture of the

clinical area. The past Director was Dr. Marshall, who was a
laid-back administrator/manager. He had been the Director for
over 10 years and had become very comfortable in his position.
Times were such that the academic medical center did very
well. It could rely on not only strong revenue from good paying
patients, but a steady stream of investment income, based on a
successful fundraising campaign from a few years back. Dr.
Marshall had a strong relationship-oriented leadership style and
got along well with all his direct reports. He empowered the
physicians, residents, nurses, and other operating room staff to
manage their areas without much of his involvement. He was
well-liked and oftentimes socialized with the Department
personnel outside of work.
The downward trend with the economy has taken its toll on St.
Gerard. The insurance mix has changed from a private base with
partial government program support to one highly dependent on
government payers. The community demographics have changed
to being older and, therefore, more Medicare patients have
entered the facility. The unemployment rate surrounding St.
Gerard has increased and many people who once had private
insurance through their employers are now on state aid
(Medicaid). The net revenue of all departments has decreased,
especially in the Surgery Department, not only from the change
in payer mix, but also because elective surgeries are being
postponed.
Dr. Marshall received a lot of pressure from the Vice President
of Medical Affairs to decrease costs in the operating room. He
did not feel up to the challenge at this point in his career and
decided to retire earlier than he once expected. A new physician
has been appointed as the Interim Director. Dr. Silver is a much
younger surgeon who has impressed the VP with her efficient
surgeries. She has the best on-time operations and all her peer
scores are in the 90th percentile. She has been very effective
working with the nurses on improving their Surgical Care
Infection Prevention Scores (SCIP) and is active in the Surgery
Department meetings, often volunteering to be on special

subcommittees.
Dr. Silver is anxious to turn things around. Even though she is
only appointed as Interim Director, she wants to prove her
abilities as an administrator and make some immediate changes
in the Department. She has weekly meetings with her medical
directors and managers. She is enforcing hospital rules that
have been ignored for many years, like the dress code and
appropriate professional behavior. She makes rounds daily and
even scrubs up to observe what is happening during procedures.
Dr. Silver believes in accountability and is holding her staff
responsible for good performance and for reducing costs. A few
employees have already been written up for not following
through on policy changes. She tries to stay current by reading
journals in the field and has read an article about the value of
transparency in work units. Impressed with this best practice,
she immediately begins posting productivity results, which
embarrasses the poorer performing doctors and clinical staff.
The Surgery Department faculty and staff are grumbling about
all the changes taking place. Even though they seem to
understand the necessity for all the changes and more active
leadership, they feel Dr. Silver is micromanaging and does not
trust them. They also believe that the changes are just
happening too fast. The faculty and staff are concerned about
their job security. The more senior associates want to approach
Dr. Silver and let her know of their concerns. The more junior
associates are afraid to be included in this meeting and would
rather just stay silent and see how things progress. Now these
two groups of workers are beginning to form a division due to
how they want to address these issues.
1. What should the faculty and staff do to address their
concerns over Dr. Silver’s leadership?
2. Do you think Dr. Silver’s being an “Interim” Director
affects the way the associates are reacting?
3. What do you think Dr. Silver should have done to make an
easier transition for the employees after Dr. Marshall’s

departure?
4. Should the Vice President of Medical Affairs get involved
if the physicians come to him and say that the morale is down in
the Surgery Department due to the new Director’s style?
5. Would you rather work under a Director with Dr.
Marshall’s leadership style or Dr. Silver’s and why?
Buchbinder, S. B., & Shanks, N. H. (Eds.). (2012). Introduction
Bartlett.
Manion, J. (2011). From management to leadership: Strategies
for transforming health care (3rd ed.). San Francisco, CA:
Jossey-Bass.
Northouse, P. G. (2012). Introduction to leadership: Concepts
and practice (2nd ed.). Thousand Oaks, CA: Sage.
Studer, Q. (2009). Straight A leadership: Alignment, action,
accountability. Gulf Breeze, FL: Fire Starter.
Totten, M. K., & Paloski, D. (2011). Transparency:
Considerations for CEOs and boards. Healthcare Executive,
26(5), 76–78.
CASE 10
The Toxic Leader
Marie-Elena Barry
Kyle was a BSN-prepared psychiatric nurse with two years of
nursing experience under his belt, and was viewed by his peers
as being a senior nurse. Currently, he attends a graduate
program part-time to earn his MSN, with hopes to be a manager
of an inpatient psychiatric unit. Whenever Kyle was on duty he
was always in charge of the 12-bed inner city psychiatric unit.
He worked on 3 West caring for young adult patients who
suffered from developmental disabilities with a codiagnosis of
psychiatric conditions such as schizophrenia, autism, or bipolar
disease.
Every Tuesday and Thursday afternoon, the unit participates in

patient care conferences. The purpose of the conference is to
discuss patients who represent a challenge for staff or someone
who has behaviors that require interdisciplinary collaboration in
order to provide a safe and therapeutic milieu. In order to
maintain compliance with The Joint Commission, the
psychiatrist, nurse manager, pharmacist, psychologist, and
representatives of nursing, social work, and recreational therapy
are expected to attend. Jackie, the unit manager, is the Chair of
the patient care conferences.
The psychiatric unit follows a primary care nursing model, and
Kyle was the primary nurse for K.C. Kyle reflected that just two
days prior to the scheduled care conference, K.C. was verbally
threatening to staff and patients. Additionally, he stopped eating
and was banging his head on the wall. On the day of the patient
care conference, K.C. had physically assaulted another patient.
Kyle, having just two years of nursing experience, was having
difficulty in managing K.C.’s disturbing behavior. Kyle
acknowledged that K.C. was a danger to himself and others, and
Kyle was looking for guidance and support from the health care
team.
Thursday at 2 pm, Kyle entered the conference room, as
expected, only to find that he and the recreational therapist were
the only staff present. This wasn’t unusual since when Jackie,
the unit manager, sporadically attended rounds, she was often
late. Ten minutes after the meeting was supposed to start, Jackie
passed by the conference room while talking on the phone, and
asked the person she was speaking with to hold on for a minute.
As she hurriedly walked away, Jackie told Kyle and the
recreational therapist the meeting was cancelled and, “Oh, by
the way, didn’t you get my e-mail?” Kyle was speechless. He
had never received an e-mail from Jackie, and was disappointed
as yet another patient care conference went unattended by the
management team.
In the meantime, Kyle was at a loss on how to positively
manage the care for K.C. The unit was getting out of control as
K.C. was becoming more aggressive with other patients. On the

afternoon of the cancelled meeting, Kyle saw Jackie and asked
her for a moment of her time. Jackie stated that she was late for
an appointment as she briskly walked towards the door. She
asked Kyle to e-mail her so they could set up an appointment
for a more convenient time. Immediately, Kyle sent an e-mail to
Jackie stating that he was accessible anytime, even on his days
off. Days went by and Kyle never received a reply.
On Kyle’s next shift, he patiently waited for his unit manager to
arrive. He needed to discuss the care of K.C. with her. When
Jackie finally arrived at work, she was wearing a too-short
sequined dress, large gold hoop earrings, and three-inch heels.
As she had barely entered the psychiatric unit, Kyle noticed that
she was hanging on Martin’s arm and giggling flirtatiously.
Kyle remembered that Martin was complaining earlier that
morning that he had scheduled a meeting with Jackie to discuss
a staff squabble. To make matters worse, Martin, who was a
younger and less senior nurse followed Jackie into her office
and slouched comfortably into the leather chair across from her
desk. Jackie hurriedly ran into her office and closed the door.
1. What is going on in the case?
2. What is the nature of this organizational problem?
3. Which theory or theories best describe the behavior of the
nurse manager?
4. How does Jackie’s behavior affect workplace morale?
5. What kind of clinical and financial impacts do you think
Jackie’s behaviors might have on the hospital?
6. What further actions do you recommend for Kyle to manage
the safety of his patient and the unit? What kind of data will
Kyle need to collect?
7. How would you handle this scenario if you were Kyle?
8. Provide your reflections and personal opinions as well as
your recommendations for addressing this problem.
Role Play
Kyle: One student is Kyle. It is that student’s job to confront
Jackie. Keeping in mind the Discussion Questions and

Additional Resources for this case, how can Kyle ensure safe,
effective patient care and protect himself in this situation?
Jackie: One student is Jackie, the unit manager. It is that
student’s job to convince Kyle that his fears are unfounded. She
is his boss and Chairperson of the patient care conferences.
Keeping in mind the Discussion Questions and Additional
Resources for this case, how can she defend her behaviors?
Borkowski, N. (2011). Organizational behavior in health
care (2nd ed.). Sudbury, MA: Jones and Bartlett.
Bartlett.
Dupree, E., Anderson, R., McEnvoy, M., & Brodman, M.
(2011). Professionalism: A necessary ingredient in a culture of
safety. The Joint Commission Journal on Quality and Patient
Safety, 37(10), 447–455.
Fallon, L. F., & McConnell, C. R. (2007). Human resource
management in healthcare: Principles and practices. Sudbury,
MA: Jones and Bartlett.
Kusy, M., & Holloway, E. (2009). Toxic workplace! Managing
toxic personalities and their systems of power. San Francisco,
CA: Jossey-Bass.
Malloy, T., & Penprase, B. (2010). Nursing leadership style and
psychosocial work environment. Journal of Nursing
Management, 18, 715–725.
Morrison, E. E. (2011). Ethics in health administration: A
practical approach for decision makers (2nd ed.). Sudbury, MA:
Jones and Bartlett.
Patterson, K., Grenny, J., McMillan, R., & Switzler, A.
(2004). Crucial confrontations. New York, NY: McGraw-Hill.
Patterson, K., Grenny, J., McMillan, R., & Switzler, A.
(2011). Crucial conversations: Tools for talking when stakes are
high (2nd ed.). New York, NY: McGraw-Hill.
Perez, B., & Liberman, A. (2010). Sexuality in the workplace:
Where do we stand? The Health Care Manager, 29(2), 98–116.

CASE 11
Inappropriate Client Behavior
Joshua H. Buchbinder
The management of Peak Performance Health and Wellness
Club has received several emails and verbal complaints about an
unidentified male club member allegedly masturbating while
using the equipment in the club. The only description they have
of the accused is that he is an older, white male with glasses.
Jim Roberts is a personal trainer and is just about to start a
morning session with a client. A young woman he knows and
trusts comes up to Jim with a frantic expression. “Come
quickly.” She can barely get the words out. “There’s a man on
the stationary bike who is staring at a woman’s chest and
masturbating.”
Jim excuses himself from his session and goes to see for
himself. The member points out the accused male, and Jim
immediately contacts his department head and another male
trainer, just in case there’s an incident.
Jim taps the accused member on the shoulder. “Can I have a
word with you?”
The older man agrees, and they step over to the side. Jim knows
this man and has had conversations with him in the past
regarding his joint surgery and his postoperative rehabilitation.
Jim believes he should be able to get to the bottom of this
matter quickly.
“A member reported to us that you were touching yourself
inappropriately.”
“What’s inappropriate? Your definition of inappropriate and
mine might be completely different!”
“Were you fondling yourself?”
“What’s fondling? I don’t know what that means.”
“You had your hands in your pants.”
He shrugs. “So, we have to adjust ourselves. I can have my hand
in my pants.”

At this point Jim becomes frustrated and just comes out and
asks, “Were you masturbating?”
The member becomes very defensive and says, “I never do that,
I can’t believe you accused me of that, I’m offended !”
Jim asks the man to stay where he is. He knocks on the general
manager’s (GM) door and quickly fills him in on the situation.
Jim and his team escort the accused member to the GM’s office.
The GM repeats the same line of questioning, and the man gives
verbatim answers to the ones he gave Jim. Eventually, the GM
gets as frustrated as Jim was and asks, “Were you
masturbating?”
The man puts his hand on his chest and an indignant expression
on his face. He shouts, “I NEVER DO THAT! I demand to face
my accuser; I have the right to face my accuser. I’ve been a
member since this club opened! I can’t believe that you would
suggest this.”
At this point the GM is not amused or buying his story. He
simply tells the man his membership will be on suspension
pending an investigation.
The member continues to argue but eventually calms down. He
then asks, “How will you let me know your decision?”
The GM tells him that the club will call him. “Can you e-mail
me instead? Let me give you my personal e-mail.”
The GM agrees and tells him that he’ll have to leave. After the
member leaves, the GM tells Jim to close the door.
He looks at Jim with a wry smile and says, “That guy
is so guilty. He wants me to e-mail him privately so his wife
won’t find out.”
Jim goes upstairs with his boss to speak with the female
member who reported the incident. When he finds her, she is
with another female member. The second female member tells
Jim that he was the same man that she saw masturbating on a
treadmill and wrote an email about. Jim’s boss takes statements
from the two female members so Jim can return to his now
shortened session with his client.

1. What are the facts in this situation?
2. Should anyone who observed the behavior feel obligated to
report it? Why do you think only female members reported the
behavior?
3. Is this a criminal activity and should it be reported to
police?
4. Should the club install video surveillance equipment to
deter this …
CASE 2
Changing Physician Credentialing
Dale Buchbinder
You are the Chairperson of the Department of Surgery and you
attend the quality committee meetings. You do not have a vote
on the quality committee because you need to carry out the
recommendations of that committee. The committee is
reviewing several cases of Dr. Monitor, one of the busiest
surgeons on staff. These cases have had bad outcomes and the
committee is concerned about Dr. Monitor’s surgical judgment.
When each case is reviewed individually, it appears the issues
are minor. However, upon detailed review of many of Dr.
Monitor’s cases, a devastating pattern of events has emerged
and the committee feels his practice patterns are not safe for the
patients at this hospital.
The committee has several choices; all choices are, however,
only recommendations to you, the department Chairperson. The
surgeon under scrutiny is not known to be arrogant or malicious
and is, in fact, well liked. When you discuss these events with
the partners in his practice, you find they are also concerned
about Dr. Monitor’s practice patterns. You ask the committee to
hold off on a recommendation giving you the opportunity to
discuss the situation with the surgeon.
After a very open discussion with Dr. Monitor and one of his
partners, the Division Chief, you ask Dr. Monitor to voluntarily
give up his privileges to perform the procedures that are in
question. After being informed that he can only assist one of his

partners in the procedures of concern, Dr. Monitor cordially
agrees to comply with this recommendation. At the next quality
committee meeting, you announce Dr. Monitor has volunteered
to reduce his privileges.
1. What are the facts in this situation?
2. Dr. Monitor volunteered to reduce his privileges. Does this
event constitute a disciplinary action? Is this required to be
reported to the physician licensing board?
3. What obligations, if any, does the Chairperson have to
report this to other hospitals where Dr. Monitor has privileges?
4. If Dr. Monitor had been a difficult personality to deal with,
do you think the Chairperson of surgery would have proceeded
in the same manner? What type of communications do you think
might have occurred in that scenario? Provide your reflections
and personal opinions as well as your rationale for your
responses.
5. Physician credentialing and privileging is a duty of the
hospital Board of Trustees (BOT). The BOT delegates this
responsibility to physician experts on the hospital staff. If the
quality committee and the Chairperson of surgery had not done
their jobs, what might the repercussions have been for patients
and for the hospital? Provide your reflections and personal
opinions as well as your rationale for your responses.
Borkowski, N. (2011). Organizational behavior in health care
(2nd ed.). Sudbury, MA: Jones and Bartlett.
Bartlett.
Greene, J. (2008). It’s a privilege: The board’s role in physician
credentialing and privileging. Trustee: The Journal for Hospital
Governing Boards, 61(3), 8.
Health Resources and Services Administration (HRSA). (n.d.).
National practitioner data bank. Retrieved from
Illinois court upholds imposition of summary suspension of

physician’s open-heart surgical privileges. Lo v. Provena
Covenant Medical Center. (2004). Hospital Law Newsletter,
21(7), 1–5.
Jones and Bartlett.
Schneider, D., & Rapp, J. (2005). Credentialing for carotid
artery stenting. Perspectives in Vascular Surgery and
Endovascular Therapy, 17(2), 127–132.
Senft, D. (2002). Laws governing peer immunity, physician
credentialing upheld. Managed Care, 11(2), 62–63.
Tammelleo, A. (2002). Patient sues hospital for failure to
regulate surgical privileges. Hospital Laws Regan Report,
43(4), 2.
Unnecessary procedures: Court puts responsibility on nurses to
report physician’s actions. (2010). Legal Eagle Eye Newsletter
for the Nursing Profession, 18(9), 7.
CASE 3
The New Manager Needs a Coach
Sharon B. Buchbinder
Flora Fauna was promoted from a floor nurse to nurse manager
of a surgical services floor at Happy Days Hospital (HDH), a
400-bed community hospital known for excellence in nursing
care. The CEO of HDH believes the best managers come from
the best clinicians because they are close to patient care issues.
Flora was selected for promotion over three other nurse
applicants because of her excellent scores on patient care, team
work, and her course work toward her master’s in nursing
administration. Delighted with her promotion, Flora decided to
take charge immediately and called a meeting of the staff who
reported to her.
At the gathering she asked people for input on what they would
like to see changed. When one of her former coworkers spoke
up and suggested that they hire another full-time RN, Flora
crossed her arms, frowned, and shook her head. “No, no, no.

Too expensive. That just isn’t possible.” She looked around the
room. “Do any of you have ideas that won’t break the bank?”
Silence fell over the room like a heavy blanket. “I don’t
understand. All you guys ever do is complain about being
overworked. If you’re not part of the solution, then you’re part
of the problem. I can’t be expected to fix everything by myself.
If you don’t have any reasonable ideas, then we might as well
finish this meeting.”
Unbeknownst to Flora, her boss, Ida Caresalot, happened to be
near the open door and heard everything. Ida waited for the
staff to disperse and invited Flora to come to her office.
“Flora, I think you have a lot of potential. Right now, you
would benefit from a leadership coach. We only offer this type
of mentoring to people we believe will become good leaders in
our organization.”
Flora was floored. She just got the job and already she was
being told she had to be retrained. On the other hand, Ida said
this was an investment in Flora’s future with the hospital. She
took a deep breath and asked, “What’s involved in this
coaching?”
“You would have a 360-degree evaluation by family,
colleagues, and stake-holders using a survey that assesses
Emotional Intelligence (EI). We know managers who have
strong emotional intelligence skills outperform those who don’t.
We don’t do this just to be nice. It’s good business. EI
encompasses self awareness, self regulation, self motivation,
social awareness, and social skills, and within each of these
areas, specific skill sets.”
Flora agreed to participate in the EI360 and EI coaching. When
she read the results of the EI360, the following scores upset her:
• Adaptable/Flexible (60%; normal range 64–80%)
• Communication (62%; normal range 66–83%)
• Emotional Self Awareness (70%; normal range 61–81%)
• Empathy (65%; normal range 61–80%)
The feedback on empathy was most distressing to her, despite
being within normal limits, because she was a nurse and in the

“helping professions.” She assumed she excelled in that
competency. Didn’t she always ask her people for input? Wasn’t
she always available? Or so she thought. Clearly, others did not
see her the way she saw herself.
At Flora’s first one-on-one session, her coach asked what she
wanted to get out of the experience. Flora said, “I want to be a
better listener.”
The first month, the coach had her focus on her listening skills.
Flora had one-on-one meetings with every member of her staff
and asked what she could do to make their jobs better. She kept
a notebook of observations of when listening experiences went
well and when they went poorly. After a two-week time period,
Flora found her best listening and best outcomes occurred when
• she was prepared with script, notes, data, lists, and plans;
• she trusted the other person; and,
• she was calm and relaxed.
Flora also found her worst listening and worst outcomes
occurred when
• she felt under attack or sandbagged;
• she was told her facts/perceptions were not real; and,
• old history was dredged up, and was not relevant to the
current situation at hand.
Flora scheduled a second meeting with the entire staff for the
following week and hoped she’d do better this time.
1. What is going on in this case?
2. What is the nature of the organizational behavior problem?
3. What are three things contributing to this problem?
4. Why do you think Flora behaved the way she did at her
first staff meeting?
5. Based on the information provided in this case, what do
you think Flora should do in preparation for her next meeting?
What other resources might she want to bring into the meeting?
6. Have you ever had a manager who could have used EI
coaching? Is this something you think you would like to take
advantage of for your own leadership development? Provide

your reflections and personal opinions as well as a rationale for
your responses.
Buchbinder, S. B. (2009, July 29). Emotional intelligence and
leadership. Retrieved from
Bartlett.
The Consortium on Research for Emotional Intelligence in
Organizations. (2009). The emotional competence framework.
Retrieved from
Fallon, L. F., & McConnell, C. R. (2007). Human resource
management in healthcare: Principles and practices. Sudbury,
MA: Jones and Bartlett.
Goleman, D. (1998, December). What makes a leader? Harvard
Business Review, 76(6), 93–102.
Goleman, D. (2006). Social intelligence. New York, NY:
Bantam Books.
Hatfield, E., Cacioppo, J. L., & Rapson, R. L. (1993).
Emotional contagion. Current Directions in Psychological
Sciences, 2(3): 96–99.
Jones and Bartlett.
CASE 4
Why Won’t She Just Retire?
Sharon B. Buchbinder
Denise Gogetter, RN, MSN, has been at City Medical Center
(CMC) for two years as the Assistant Vice President of Nursing
(AVP). She is a hard working, bright, articulate nurse who has
contributed many creative ideas for providing excellent quality
of care at CMC. Recently, however, she has gone from a
pleasant, easy-to-work-with coworker to a cranky one. She used

to bubble with enthusiasm about her job and the opportunities it
afforded her. Denise made no secret of the fact that she wanted
to advance within the organization.
Today she comes up to you in the cafeteria and says, “If I have
to work for Rose Durham one more week, I’ll scream.”
You’re more than a coworker, you’re Denise’s friend, and you
are the AVP to the CFO. You are alarmed by her tone of voice
and suggest you go out after work to discuss the matter. Over
coffee and dessert, Denise confides that when she was hired,
she was promised a promotion at the end of 2 years. As soon as
Rose retired, she was supposed to be the VP of Nursing.
However, today HR informed Denise the promotion was not a
promise, merely a possibility mentioned to her during
recruitment. Rose, like many others, had been hard-hit by the
recession and was not in a financial position to retire. She
decided to put off her retirement to age 70, instead of 65. And
Rose wasn’t interested in taking a cut in pay and stepping down
from her role. Denise has no interest in remaining as an AVP.
She’s ready to be promoted NOW.
While you understand Denise’s frustration, you wonder to
yourself how such a major misunderstanding could have
occurred. Denise took copious notes at every meeting. The
recruiter, who was an independent headhunter, put nothing in
writing except for e-mails setting up interview days and times.
Denise shows you the letter from HR. It is a standard letter with
salary, start date, and benefits package. The letter includes
nothing about opportunities for advancement, nothing about
promotions, and nothing about older nurses retiring to make
way for younger nurses.
Did the headhunter really promise her a promotion after two
years? Or did Denise read more into the statements than was
there?
1. What are the facts of this case?
2. What is the nature of the organizational behavior problem?
3. What are three factors contributing to this dilemma?

4. What are the top three management issues in this case?
5. Who should be responsible for addressing these
organizational issues?
6. Headhunters earn commissions on finding candidates for
jobs. If the employee stays for a year or more, the headhunter
often gets to keep a large amount of money. Do you think the
headhunter made promises she couldn’t keep? Or, do you think
Denise heard what she wanted to hear?
7. Do you think Denise should have wondered if the
headhunter’s promises were too good to be true? Should she
have insisted on getting those statements in writing?
8. At this point in time, what, if anything, can Denise do?
What choices does she have? Provide your reflections and
personal opinions as well as your recommendations and
rationale for addressing this problem.
Baker, J., & Baker, R. M. (2011). Health care finance: Basic
tools for nonfinancial managers (3rd ed.). Sudbury, MA: Jones
and Bartlett.
Bartlett.
De Milt, D., Fitzpatrick, J., & McNulty, S. (2011). Nurse
practitioners’ job satisfaction and intent to leave current
positions, the nursing profession, and the nurse practitioner role
as a direct care provider. Journal of the American Academy of
Nurse Practitioners, 23(1), 42–50.
Feldman, L. (2010). Report: New workforce models needed to
adapt to changing environment. H&HN: Hospitals & Health
Networks, 84(3), 12.
Jones and Bartlett.
Palumbo, M., McIntosh, B., Rambur, B., & Naud, S. (2009).

Retaining an aging nurse workforce: Perceptions of human
resource practices. Nursing Economics, 27(4), 221.
Patterson, K., Grenny, J., McMillan, R. & Switzler, A. (2004).
Crucial confrontations. New York, NY: McGraw-Hill.
Patterson, K., Grenny, J., McMillan, R. & Switzler, A. (2011).
Crucial conversations: Tools for talking when stakes are high.
New York, NY: McGraw-Hill.
Two-thirds of managers report economy has affected staffing.
(2011). OR Manager, 27(9), 1–10.
CASE 5
No Plan in Sight? Succession Planning in a Small Rural
Hospital
Amy Dore
Stratlin Memorial Hospital is located in Keen, Kansas, a small
rural town in the Midwest. The county seat of Markley County,
Keen has a population of 6,128, not including cows. Markley
County is an area of 1,856 square miles that consists of farming
and agriculture, which are also the main sources of jobs for the
county residents, specifically corn, wheat, soybeans, and
alfalfa. There are also numerous livestock farms. The town of
Keen is unique in its geographic positioning and unique
attractions. Keen lies along Interstate 35, 49 miles south and 37
miles east of the next largest urban cities. A major attraction for
visitors to Keen is the Toy & Action Figure Museum and a well
known chocolate factory.
If you ask residents why they live in Keen, they reply by telling
you that the community is family oriented, peaceful, traffic-
free, and has plentiful parks and recreation activities and
abundant grocery stores, including local farmers’ markets. Of
course, Keen comes with its challenges that are standard in
small rural towns, including residents that are older and have
lower education levels, lower income status, and less healthy
lifestyles. The area is also characterized by occasional droughts,
lack of seat belt use, farming accidents, large numbers of
residents who are uninsured and underinsured, limited business

growth, and high incidences of kidney disease and chronic
obstructive pulmonary disease (COPD).
Stratlin Memorial Hospital opened its doors in 1970, but has a
long-standing history dating back to 1905 when Drs. Calhoun
and Lewis partnered to form the first 5-bed hospital, known as
the Keen Sanitarium. The current hospital has 45 set-up and
staffed beds, and offers services in acute care, emergency care,
home health services, diagnostic testing, surgical services,
laboratory services, hospice care, and therapy services. There
are 130 full-time equivalent (FTE) staff and 145 employees
working at the hospital, including 8 active staff physicians, 1
certified registered nurse anesthetist (CRNA), 1 full-time
surgeon, and 1 full-time physician assistant (PA). Stratlin
Memorial Hospital is one of the three base sites for the county-
wide emergency medical service (EMS). The hospital averages
180 admissions and 147 emergency room visits per month, and
approximately 7,300 outpatient visits per year. There are on
average 45 babies born at Stratlin Memorial Hospital each year.
Additionally, in 2007, an independent and assisted living center,
The Willows, was built directly east of the hospital’s parking
lot. There are four senior administrators including an interim
CEO, a CFO, a part-time interim CNO, and an Ancillary Service
Director. There are 16 managers within the hospital for the
varying departments and service areas. The average tenure for
the hospital managers is 14.25 years.
Up until two years ago, the hospital had a very stable senior
administrative staff. The CEO had 21-year tenure, the CFO 19-
year tenure, and the CNO 33-year tenure. Due to unexpected
health conditions, the CEO was forced into immediate
retirement. Since his retirement, Stratlin Memorial Hospital has
had two CEOs, neither lasting more than nine months. This
situation mimicked a domino effect where the first quit because
his wife did not like the rural lifestyle, and the second was fired
due to shady dealings within the hospital. The two other
members of the senior management team voluntarily quit and
retired. Plans are currently underway to promote the interim

CNO to full-time status.
Stratlin did not have a succession or mentoring plan in place. It
had never seemed necessary, as it was assumed that longevity
within a job (clinical and administrative) had worked in the past
and would continue. In fact, hospital cofounder Dr. Calhoun’s
great-great-grandson recently retired as a general surgeon,
ending a 100 year family legacy of physicians at Stratlin
Memorial Hospital. The Stratlin Board of Trustees, which has
always been comprised of five community leaders and
volunteers, never thought succession issues of the
administrative and clinical staff would become a problem.
Currently, the Board is comprised of four males and one female.
The men range in age from 55 to 74, and the female board
member is 31 years old. Occupationally, the board members
come with a range of career experiences. However, only one
board member has any clinical background. The others are
community members, including a high school teacher, an
attorney, the city art director, and the local grocery store owner.
Obviously, many things had changed for everyone involved.
The aim of succession planning is to ensure there is an
appropriate training and development program for junior
employees as a method to prepare them to assume increasingly
higher level positions of leadership throughout their tenure.
Stratlin Memorial Hospital has learned its lesson. Although not
initially prepared to address resignations and retirements, the
Board has hired you as its consultant to create a succession plan
with the focus on their troubled senior administrative staff. In
order to make consultative recommendations, what are the next
steps you must complete to prepare for this role?
1. What is the current situation at the hospital?
Which organizational theories do you think best apply to this
situation?
3. What are Stratlin’s areas of strengths? What are its
weaknesses?

4. What should a short-term plan to immediately handle the
management situation include? Should they consider promoting
from within to help alleviate the immediate situation, such as
appointing an interim administrator; utilizing a temporary “on-
loan” executive; or developing alternative strategies?
5. What role might hospital politics have played in the rapid
turnover of CEOs?
6. How will you educate the Board of Trustees about
succession planning? What role should they play in this
process?
7. How would you introduce the concept of succession
planning to the staff of Stratlin Memorial Hospital? Should
workshops be used to familiarize the management staff with the
succession issues? Should you include all managers in the
process?
8. What recommendations and steps are needed in order to
establish a long-term plan for continued succession planning?
Who should be involved and lead this process?
9. Should the institution adopt a succession plan for clinical
staff members?
Alexander, J. A., & Shoou-Yih, D. L. (1996). The effects of
CEO succession and tenure on failure of rural community
hospitals. Journal of Applied Behavioral Science, 32(1), 70–88.
Bartlett.
Ledlow, G. R., & Coppola, M. N. (2011). Leadership for health
professionals. Sudbury, MA: Jones and Bartlett.
Rubino, L. (2012). Leadership. In S. B. Buchbinder & N. H.
Shanks (Eds.), Introduction to health care management (2nd ed.,
pp. 17–38). Burlington, MA: Jones & Bartlett.
Sniff, D. D. (2008). Succession planning for rural hospitals
[PowerPoint slides]. Retrieved from
CASE 7

Practicing Organizational Culture Without a Leader
Dea Robinson
Small Feet OB/GYN was at one time a robust practice with five
physicians, a midwife, and two PAs. The practice had a strong
following in the community, was trusted by the many women it
had served, and recently began delivering “legacy” babies of
patients. Dr. Smith was the founder of the practice and had been
the lead physician for many years.
Two competing systems with hospitals only one mile apart had
vied for the affiliation with the Small Feet practice. Dr. Smith
decided to change her affiliation to the other hospital. As a
result, the practice experienced a move that seemed to only
strengthen the patient base, and the new space (which was twice
as large as the previous office) seemed to suit the new practice
well.
The medical staff and CEO of the new hospital supported Dr.
Smith’s move for several reasons. First, Dr. Smith, as
mentioned, was delivering legacy babies and in the OB/GYN
field this speaks to the trust the provider has been able to create
and sustain throughout the years. This resulted in lots of
community goodwill; that intangible quality is highly sought
after in the medical community, yet is so difficult to quantify.
Second, the new affiliation of Dr. Smith and her patients would
bring positive revenues to the hospital through the move.
Finally, the new hospital had a Level 1 trauma center, known
for neurological cases, but not for delivering babies. The
expansion of labor and delivery with the addition of a seasoned,
legacy-delivering physician was a real coup for the hospital to
attain.
Dr. Smith became ill and had to go on medical leave for almost
a year. During that time the cohesiveness among the other
providers suffered. When Dr. Smith came back things were very
different. Dr. Smith became suspicious of everyone and had
feelings that the staff and other providers were conspiring
against her. Her suspicious attitude toward the physicians and
staff in her practice led to dysfunctional problems throughout

the practice. When Dr. Smith was confronted by the manager,
Amy, she became distrustful and suspicious that Amy was
conspiring with the other providers in the group against her.
The practice had also gone through some growing pains from a
one-physician practice to five. Though originally the physicians
worked well together, they now seemed to be less willing to
collaborate. The practice also suffered as a result of a manager
who had not kept up with the managerial requirements needed to
run a midsize practice. For example, staff and provider
performance reviews had never been done, the physicians had
not established policies and procedures for the practice, there
was no employee handbook, and tardiness was an acceptable
behavior among the ranks.
When Dr. Smith wanted to complete a performance review on
Amy, who had been with Small Feet for 13 years, she handed in
her resignation the next day. Subsequently, three providers
resigned and set up practices on the same hospital campus.
Since the provider contracts (the ones who had one) were
devoid of noncompete clauses, the providers exercised the right
to set up a practice and some of them went into practice
together.
Dr. Smith hired a consultant, Mary, to assist with management,
as well as to handle the financial side of the practice. The
consultant hired a new administrator, Susan, who had an MBA
but little day-to-day experience. She subsequently resigned for
another position with a large medical system. Mary provided an
exit interview with Susan, even though Mary had mentored and
been closely involved with Susan the entire time. Ironically,
through the exit interview, Susan stated the reason for leaving
was not because of the pay, but because of Dr. Smith’s harsh
treatment of her, as well as her lack of appreciation and
teamwork.
Now the practice can barely make payroll or cover other
practice payables. The remaining staff is afraid of being laid off
or fired due to the arbitrary and erratic lead physician behavior.
You have just been hired as the administrator and learn about

the many problems only after you’ve come on board. Other
problems soon emerge. Embezzlement is discovered, and the
lead physician was the only signer on the accounts. There was
no system in place for ordering supplies or managing payroll;
these duties had been performed by the prior manager verbally
with no paper trail. Credit balances owed to patients had been
written off at the end of the month by the manager. It was later
discovered the practice owed new mothers and postsurgical
patients almost $80,000 in credits that had been written off.
Dr. Smith contends that the culture of the practice comes from
management, although it has been shown that culture comes
from the “top.” Dr. Smith refuses to accept this, and continues
to blame her staff for all of the problems that are at the
forefront of the practice. You need to break this news to Dr.
Smith and make suggestions on how to tackle the debt and how
to manage the practice. One option is to encourage her to
become a hospital system employee where she would have no
control over management decisions. You know Dr. Smith does
not want to become an employed physician due to her control
issues; however, you see few options with the insurmountable
debt as well as the clinical responsibility of the large patient
base (most of whom are pregnant). The simple act of treating
patients in the clinic has become difficult because supplies and
devices (IUDs, etc.) cannot be ordered due to the lack of
working capital.
Which organizational theories do you think apply best to this
situation?
2. Make a list of things you need to do as the new
administrator and prioritize them. What would you do on day
one if you were the administrator in this practice? What data
would you collect on the first day in order to go forward? What
would you do next? Provide a rationale for your list and
priorities.
3. What type of management style does Dr. Smith practice

here?
4. What steps would you take to address and disclose the
embezzlement issue to her?
5. How would you actively manage the staff in this
environment of …
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Assignment meets some expectations with minimal depth and
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present and appropriate for the assignment.
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points, but does not synthesize. Provides minimal justification
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Synthesizes and justifies (defends, explains, validates,
confirms) information gleaned from sources to support major
points presented. Uses a minimum of two credible resources in
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