Deciding Whether to Centralize or Decentralize

The new Graystone Memorial Clinic facility houses 50 specialists. The old clinic building was located in a gradually decaying portion of the city, and the group decided to build a new facility to allow for expansion of the staff and to better serve the population, which has shifted away from the original location.

During the course of planning for the project, a number of decisions regarding functions were made. One important decision was to centralize the nursing station on each floor, with approximately twelve physicians housed in each unit and 3-4 in each subspecialty section. This was done in order to increase efficiency. Although the physician’s offices and the exam rooms all had telephones, telephone calls to the floor were to be handled centrally within the nursing section. Other duties of the nursing and office staff were also to be shared. As a patient was brought back from the central reception area with the chart, the chart was to be placed in a pocket outside the patient’s exam-room door, and the flag indicator moved to alert the physician that this was his or her next patient. 

The move was completed over a weekend, and the doors of the new facility opened to patients for the first time on the following Monday. Within an hour, utter chaos reigned. The chief of medicine became so upset that he threatened to resign. The problem was that the physicians did not accept the centralization of the nursing staff because they felt they could not operate without having their own personal assistant.

Somehow the clinic floundered through the first week, with growing tension among employees, professional staff, and administrators. The following Monday, a special meeting of the partnership was called to consider the design problems of the new building.

1. Assume that you are the administrator of the Graystone Memorial Clinic. What went wrong, and how would you correct the problem?