Read through the case study, and answer the questions following the case study. You do not need to follow APA guidelines in your discussion posts; however, you MUST still provide attribution for your outside sources. The use of at least two scholarly/academic sources is required.  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.

1. Read through the case study, and answer the questions
following the case study. You do not need to follow APA
guidelines in your discussion posts; however, you MUST still
provide attribution for your outside sources. The use of at least
two scholarly/academic sources is required.
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.

2. 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

3. 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

4. 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.
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. 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 “unknowns” among a pregnant patient base?
6. Dr. Smith wants YOU to change the culture in the
practice—how would you do this?
7. Why do you think the providers left the practice? What

5. could you have done to keep them in the practice, knowing they
could leave with their practice and associated revenue?
ADDITIONAL RESOURCES
Borkowski, N. (2011).
Organizational behavior in health care
(2nd ed.). Sudbury, MA: Jones and Bartlett.
Buchbinder, S. B., & Shanks, N. H. (Eds.). (2012).
Introduction to health care management
(2nd ed.). Burlington, MA: Jones & Bartlett.
Duden, A. (2011). Trust and leadership—Learning culture in
organizations.
International Journal of Management Cases, 13
(4), 218–223.
Edmondson, A. C. (2011). Strategies for learning from failure.
Harvard Business Review, 89
(4), 49–55.
Keyton, J. (2011).
Communication & organizational culture: A key to
understanding work experiences
. Los Angeles, CA: Sage.
Lowes, R. (1996). How a group’s personality affects its
members.
Medical Economics, 73
(24), 35+.
Schein, E. H. (2010).
Organizational culture and leadership
. San Francisco, CA: Jossey-Bass.

6. Spreitzer, G. & Porath, C. (2012). Creating sustainable
performance.
Harvard Business Review, 90
(1/2), 92–98.