18.3)Gateway Hospital is a 500-bed tertiary-care hospital located in a busy metropolitan area. Arecent employee satisfaction survey scored well below the national norms on most scales. The hos-pital has been facing higher than average turnover and vacancy rates. Recruitment of profes-sional positions is very difficult because the hospital has gained a reputation as a bad place towork, especially if one is new; the term “eat their young” seems to be a prevalent description.Salaries are below the local market, as are annual pay increases. In many departments thereseems to be a critical shortage of staff, and closing services has been a recent topic of discussion. Additionally, the financial picture of the organization is bleak. The payor mix has changed;Medicare cutbacks are impacting the bottom line, as are changes in private insurance funding.Key physicians are beginning to take their services elsewhere, as they sense the inefficiency of thehospital processes.The various stresses appear to be having a significant impact on the overall morale of employ-ees. Poor teamwork is rampant, and communication breakdowns seem to be a normal occurrence.Several leaders have been let go in an effort to address issues.The leadership of Gateway Hospital is extremely concerned about the organizational prognosisand has decided to begin to address the issues by enlisting the assistance of a consulting team.One member of the team is a financial expert who has been hired to address the significant finan-cial issues affecting the hospital. The time frame on fixing the financial issues is one of a criticalneed; since the environment is rapidly changing, the consultant must get a handle on how to helpthe hospital operate successfully, given the current financial downslide.A second member of the team is hired to address the morale and employee issues. A review ofthe employee opinion survey is conducted, and trends are identified in exit interviews. Employeeinterviews and focus groups are held in an attempt to determine the root cause of the moraleissues, as well as the breakdown in teamwork and communication.The data collection is discussed with leadership; after a series of discussions, leadership admitsthat many of the financial pressures have created a “knee jerk” reaction to staffing issues, oftencutting back dramatically on employee hours. This would create a crisis mode and the need to askemployees to work harder. This cycle has created a significant lack of trust from the employee’sperspective, coupled with the fact that employees have not felt that they have been apprised of thereasons for the roller coaster changes and have not been offered any words of appreciation whenthey have either reduced their hours or worked in a crisis.The consultant and the leadership agree that in order to fix the “people” issues of the organiza-tion, there will need to be a culture shift of leadership and employee interactions so that a trustcan be rebuilt.Questions1. On the basi ...

1. 18.3)Gateway Hospital is a 500-bed tertiary-care hospital
located in a busy metropolitan area. Arecent employee
satisfaction survey scored well below the national norms on
most scales. The hos-pital has been facing higher than average
turnover and vacancy rates. Recruitment of profes-sional
positions is very difficult because the hospital has gained a
reputation as a bad place towork, especially if one is new; the
term “eat their young” seems to be a prevalent
description.Salaries are below the local market, as are annual
pay increases. In many departments thereseems to be a critical
shortage of staff, and closing services has been a recent topic of
discussion. Additionally, the financial picture of the
organization is bleak. The payor mix has changed;Medicare
cutbacks are impacting the bottom line, as are changes in
private insurance funding.Key physicians are beginning to take
their services elsewhere, as they sense the inefficiency of
thehospital processes.The various stresses appear to be having a
significant impact on the overall morale of employ-ees. Poor
teamwork is rampant, and communication breakdowns seem to
be a normal occurrence.Several leaders have been let go in an
effort to address issues.The leadership of Gateway Hospital is
extremely concerned about the organizational prognosisand has
decided to begin to address the issues by enlisting the assistance
of a consulting team.One member of the team is a financial
expert who has been hired to address the significant finan-cial
issues affecting the hospital. The time frame on fixing the
financial issues is one of a criticalneed; since the environment
is rapidly changing, the consultant must get a handle on how to
helpthe hospital operate successfully, given the current
financial downslide.A second member of the team is hired to
address the morale and employee issues. A review ofthe
employee opinion survey is conducted, and trends are identified
in exit interviews. Employeeinterviews and focus groups are
held in an attempt to determine the root cause of the
moraleissues, as well as the breakdown in teamwork and

2. communication.The data collection is discussed with leadership;
after a series of discussions, leadership admitsthat many of the
financial pressures have created a “knee jerk” reaction to
staffing issues, oftencutting back dramatically on employee
hours. This would create a crisis mode and the need to
askemployees to work harder. This cycle has created a
significant lack of trust from the employee’sperspective,
coupled with the fact that employees have not felt that they
have been apprised of thereasons for the roller coaster changes
and have not been offered any words of appreciation whenthey
have either reduced their hours or worked in a crisis.The
consultant and the leadership agree that in order to fix the
“people” issues of the organiza-tion, there will need to be a
culture shift of leadership and employee interactions so that a
trustcan be rebuilt.Questions1. On the basis of these issues,
what OD interventions do you think should be utilized to
addressthe problems this hospital is facing?2. How would you
proceed if you were the consultant in this case?3. What skill set
do you think the practitioner will need in order to be effective
in this orga-nization?4. What type of a time line would you
establish if you were this consultant?City HospitalCity Hospital
is a growing hospital in a large metropolitan city. The hospital
is currently expe-riencing issues that many other organizations
are also facing, that of the multigenerational work-force. The
senior leadership of this hospital is the typical “baby boom”
generation, but thepopulation of employees is slowly growing
into one of a younger workforce. The leadership isstruggling to
deal with issues such as iPods at work, cell phone use, Internet
use, tattoos, bodypiercing, and so on. Equally troublesome is a
different perceived commitment to the job andbreakdowns in
communication. Leadership has decided to hire an outside
consultant to help theorganization understand the impact of the
multigenerational workforce and to try to help becomea more
cohesive organization.1. Which type of OD intervention is the
leadership using in this situation?2. What obstacles do you see
in this situation that may make this intervention more

3. difficultthan other types?3. What recommendations do you have
for this situation?4. What other interpersonal issues exist in
organizations besides generational that may create aneed for an
OD intervention?Case Stud
14.7)For each of the five scenarios described below, determine
what is the most appropriate conflict-handling style(s).Scenario
OneA radiologist on the staff of a large community hospital was
stopped after a staff meeting by acolleague in internal medicine.
On Monday of the previous week, the internist referred an
elderlyman with chronic, productive cough for chest X-ray, with
a clinical diagnosis of bronchitis. Thurs-day morning the
internist received the radiologist’s written X-ray report with a
diagnosis of “prob-able bronchogenic carcinoma.” The internist
expressed his dismay that the radiologist had notcalled him
much earlier with a verbal report. Visibly upset, the internist
raised his voice, but didnot use abusive language.How should
the radiologist handle this conflict with the internist?Scenario
TwoThe Family and Community Medicine Division of a large-
staff model HMO serves a populationthat is ethnically diverse.
The senior management team of the HMO, spurred by repeated
com-plaints from representatives of one racial group, has
encouraged the division, all of whose physi-cians are white, to
diversify. Several black and Hispanic physicians with strong
credentials applyfor the open positions, but none is hired.
Weeks later, a young female family physician learns
fromseveral colleagues that the division director has identified
her as racist and the obstructionist torecruiting. The comments
attributed to her are not only false but are also typical of
discrimina-tory statements that she has heard the division chief
utter. The rumors about her “behavior” havecirculated widely in
the division.How should the young female family physician
handle this conflict with the division chief?Scenario ThreeA
manager who reports to the Vice President for Clinical Affairs
(VPCA) of a tertiary-care hos-pital hired a young woman to

4. supervise development of a large community outreach
program.During the first four months of her employment,
several behavioral problems came to the VPCA’sattention: (1)
complaints from community physicians that the coordinator
criticizes other physi-cians in public; (2) concerns from two
community leaders that the coordinator is not truthful; and(3)
written reports about the project that label and blame others,
sometimes in language that isdisrespectful. The VPCA spoke
several times to the manager about these problems. The
managerreported other dissatisfactions with the coordinator’s
performance, but he showed no sign of deal-ing with the
behavior. Two more complaints come in, one from an influential
community leader.How should the VPCA handle this conflict
with the manager?Scenario FourThe medical school in an
academic health center recently implemented a problem-based
cur-riculum, dramatically reducing the number of lectures given
and substituting small-group learn-ing that focuses on actual
patient cases. Both clinical and basic science faculty are feeling
st, dental students took the basic course in microanatomywith
medical students. The core lectures are still given but at
different times that do not matchwith the dental-curriculum
schedule. The anatomists insist that they don’t have time to
teachanother course specifically for dental students. The dean
has informed the chair of the Depart-ment of Anatomy and Cell
Biology that some educational revenues will be redirected to the
dentalschool if the faculty do not meet this need.How should the
dean handle this conflict with the chair of the Department of
Anatomy and CellBiology?Scenario FiveThe partners in a
medical group practice are informed by the clinic manager that
one physicianmember of the group has been repeatedly
upcoding procedures for a specific diagnosis. This issuefirst
came to light six months ago. At that time the partners met with
him, clarified the Medicareguidelines, and outlined the threat to
the practice for noncompliance. He argued with their view,but
ultimately agreed to code appropriately. There were no
infractions for several months, butnow he has submitted several

5. erroneous codes. One member of the office staff has asked
whetherMedicare would consider this behavior
“fraudulent.”How should the partners handle the situation with
the other physician partner?
3.3)Write an analysis of (750-1,000 words) on quality and
performance improvement in health care.
Be sure to reference the module readings to support the
development of your paper in apa format