Lecture Notes: First Hint of Trouble    CareNet Systems            Internal Memo Date: October 2005 To: Bill Jenkins, President From: Mary Jo Larder, Director, Human Resources As you know I have been having regular meetings with hospital employees in my efforts to implement our quality assurance program. While the purpose of the meetings is educational in nature there is considerable discussion around many issues. Some of the comments concerned me enough to let you know about them. A number of people said that they believe the management is being hypocritical in trying to implement a QA program when there are so many obvious outstanding problems that could be addressed by management. 1. There are physicians who have acted abusively toward employees and yet nothing appears to have been done to correct this behavior. 2. Management is continually commenting on the financial problems the hospital is having and yet they are building new facilities instead of giving raises. 3. Employees are also concerned about the hiring freeze because many say they can't carry a greater workload. Many are worried about their jobs and said they are looking at other opportunities. 4. Because of the hiring freeze, managers appear to be tolerating sub par performance by some employees for fear of not being able to replace them. 5. Some employees noted that they are sometimes embarrassed to tell friends and neighbors that they work here because the reputation of our emergency room is not good. They commented on the long waits and rude treatment by the staff. 6. A number of people felt that management does not recognize their good performance and hard work. Mr. Jenkins, I know this is rather stark. I would be pleased to talk with you and provide more insight but I wanted to document what I heard over the past couple of weeks before I forget it. Think about it This case study presents a complex situation with different types of problems. Analyze the situation using the questions below before you read further. · What should Bill Jenkins do with this memo? How important is it? · Did Mary Larder do the right thing by sending this memo? · The memo addresses a number of issues. How would you describe each and how important is it? Rank the issues in order of importance. · How can Jenkins address the issues raised in the memo? · Is there a process Jenkins should follow in addressing these issues? · What other information does Jenkins need to respond to the contents of this memo? · Whom should Jenkins consult, both within the organization and outside it? · What are Jenkins' options? How would you prioritize them? · How would you recommend Jenkins evaluate the success or failure of each of the chosen strategies? · For each strategy, who will perceive they benefited and who will perceive they were hurt or harmed? · If a strategy is shown to be failing what are the alternatives and exit strategies? Physician Behavior Working with a medical staff requires ...

1. Lecture Notes:
First Hint of Trouble
CareNet Systems
Internal Memo
Date: October 2005
To: Bill Jenkins, President
From: Mary Jo Larder, Director, Human Resources
As you know I have been having regular meetings with hospital
employees in my efforts to implement our quality assurance
program. While the purpose of the meetings is educational in
nature there is considerable discussion around many issues.
Some of the comments concerned me enough to let you know
about them.
A number of people said that they believe the management is
being hypocritical in trying to implement a QA program when
there are so many obvious outstanding problems that could be
addressed by management.
1. There are physicians who have acted abusively toward
employees and yet nothing appears to have been done to correct
this behavior.
2. Management is continually commenting on the financial
problems the hospital is having and yet they are building new
facilities instead of giving raises.
3. Employees are also concerned about the hiring freeze because
many say they can't carry a greater workload. Many are worried
about their jobs and said they are looking at other opportunities.
4. Because of the hiring freeze, managers appear to be

2. tolerating sub par performance by some employees for fear of
not being able to replace them.
5. Some employees noted that they are sometimes embarrassed
to tell friends and neighbors that they work here because the
reputation of our emergency room is not good. They commented
on the long waits and rude treatment by the staff.
6. A number of people felt that management does not recognize
their good performance and hard work.
Mr. Jenkins, I know this is rather stark. I would be pleased to
talk with you and provide more insight but I wanted to
document what I heard over the past couple of weeks before I
forget it.
Think about it
This case study presents a complex situation with different
types of problems. Analyze the situation using the questions
below before you read further.
· What should Bill Jenkins do with this memo? How important
is it?
· Did Mary Larder do the right thing by sending this memo?
· The memo addresses a number of issues. How would you
describe each and how important is it? Rank the issues in order
of importance.
· How can Jenkins address the issues raised in the memo?
· Is there a process Jenkins should follow in addressing these
issues?
· What other information does Jenkins need to respond to the

3. contents of this memo?
· Whom should Jenkins consult, both within the organization
and outside it?
· What are Jenkins' options? How would you prioritize them?
· How would you recommend Jenkins evaluate the success or
failure of each of the chosen strategies?
· For each strategy, who will perceive they benefited and who
will perceive they were hurt or harmed?
· If a strategy is shown to be failing what are the alternatives
and exit strategies?
Physician Behavior
Working with a medical staff requires special skills and
attention. In most hospitals, the physicians are in private
practice. They are not employees of the hospital. In fact, being
a member of the medical staff is more akin to being a member
of a club. It does not instill any contractual relationship and the
chief executive officer has no authority to order a physician to
do something beyond that conferred by the medical staff by-
laws, accrediting agencies, or state licensing regulations.
Confronting a physician is a delicate matter and requires careful
preparation and execution.
Abusive behavior by physicians must be addressed. It is not just
harmful to the morale, it also exposes the organization to
liability for violating the civil rights of employees.
Nevertheless, care must be taken when this kind of behavior is
noted. If an accusation is false, the physician's reputation is
damaged and the hospital can be sued for slander. When you
don't know the exact nature of the alleged abusive behavior, it

4. is best to begin with a very quiet investigation. Bear in mind
that where one incident has been reported, there are likely to
have been others.
It is important to document meetings where grievances are aired
because the situation could result in legal action. It is also
important to keep the hospital attorney informed. At some point
Jenkins needs to bring the hierarchy of the medical staff into the
loop. Medical staff by-laws contain very specific language on
dealing with abusive physicians. Jenkins should review this
information to make sure he is complying with the by-laws.
The sooner Jenkins can put the issue of the allegedly abusive
physician into the medical staff by-law process the better.
However, he needs to take great care to make sure the process is
followed correctly and that there is legitimate investigation
done and appropriate corrective action taken.
Using your chosen refugee or immigrant group and approved
guidelines for conducting simple Internet research, prepare an
audio-narrated PowerPoint presentation about the group. You
may not use the following groups that have already been
covered extensively within the modules: Irish, Germans, Jews,
and Chinese. Click here for complete instructions and scoring
criteria (rubric).
HTY 110HA Presentation Project Instructions
Using approved guidelines for conducting simple Internet
research, choose one immigrant or refugee group and prepare an
audio-narrated PowerPoint presentation about the group.
You may not choose the following groups that have already
been covered extensively within the modules:

5. Your presentation must include slides that include the following
information:
o Photos (Required)
o Maps (Required)
o Charts
o Graphs
of origin
actors that affected your chosen group
riences of this group in
American society today
question: Based on your research, would you say that your
chosen group has attained the “American Dream?” In other
words, has America been a “Promised Land” for your group?
Why or why not?
Important