You are manager of the health information management department of Memorial Hos- pital. You have 20 people in your group. Three of your employees have the title super- visor, but all are usually more involved in doing the work of the department than in supervising others. One of these, your transcription supervisor, is expected to devote 60 percent of her time to transcription duties and the other 40 percent to supervision.

Several times in recent months the transcription supervisor has mentioned that the backlog of work was growing and that she needed more help. She has never been more specific than simply saying that “more help” was needed, and her complaints seemed to be no more than passing remarks offered without preparation or forethought. Since you have been under pressure from a number of directions and your transcription supervisor’s complaints seemed to represent no more than chronic grumbling, you have not felt compelled to add the transcription backlog to your currently active worries. Discussion Criticism and Discipline

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However, today, Monday, the transcription supervisor sought you out and con- fronted you with: “I need one more full-time transcriptionist and I need her now. I’m tired of waiting and tired of being ignored, and I’m sick of being overworked and taken for granted. If something isn’t done about it by Friday, you can find yourself a new transcription supervisor.”

Instructions:

Propose at least three possible solutions to this problem and describe the potential advantages and disadvantages of each.

The case places you in a trap. Describe this trap, explain why it is a trap, and explain how you believe you should proceed toward a solution in view of the hazards you face.

Explain what you believe is the general condition that caused the specific prob- lem described in the case. Who is responsible for the matter, and what can be done to address the cause?

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34

C a s e 2

Up froM tHe raNks

Primary Topic—Leadership

Additional Topics—Authority; General Management Practice; Time Management and Personal Effectiveness

After 8 years as a staff nurse in a medical/surgical unit, Julie was appointed head nurse of that unit. After a meeting at which her promotion was announced, Julie found herself surrounded by three coworkers offering their congratulations and other comments.

“I’m really happy for you,” said Sarah, “but I suppose this means our car pool is affected. Your hours are bound to be less predictable now.”

Elaine said, “And the lunch bunch, too. Management commitments, you know.” The emphasis on management was undeniable. Julie was not at all sure she was happy with what she was hearing.

Jane offered, “Well, maybe now we can get some action on a few age-old prob- lems. Remember, Julie, you used to gripe as much as we did.”

“We’ve all griped a lot,” Sarah agreed. “That’s been a way of life around here.” Her tone changed and her customary smile faded as she added, “Now Julie’s going to be in a position where she can do something, so let’s hope she doesn’t forget who her friends are.” Discussion Criticism and Discipline

Elaine and Jane looked quickly from Sarah to Julie. For an awkward 10 seconds or so, nobody spoke. At last, someone passing by spoke to Julie, and as Julie turned to respond, Elaine, Jane, and Sarah silently went their separate ways.

Questions:

1. What possible advantages does Julie have in becoming supervisor of the group of which she has long been a member?

2. What are the possible disadvantages that may present themselves to Julie? 3. If you were Julie, how do you believe your promotion would affect your

relationships with your former coworkers?

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35

C a s e 3

tHe sileNt GroUp

Primary Topic—Meeting Leadership

Additional Topics—Change Management; Communication; Motivation

As the admitting manager recently hired from outside, it took you very little time to discover that morale in the department had been poor for some time. As you worked to become acquainted with your employees by meeting with each of them alone, you soon became inundated with complaints and other evidences of discontent. Most of the complaints involved problems with administration and the business office and the loose admitting practices of physicians, but there were also complaints from the admitting staff about other members of the department and a couple of thinly veiled charges concerning admitting personnel who “carry tales to administration.”

In listening to the problems, you detected a number of common themes. You decided that much misunderstanding could be cleared up if the gripes were aired openly with the entire group. You then planned a staff meeting and asked all employ- ees to be prepared to air their complaints—except those involving specific staff members—at the meeting. Most of your employees seemed to think such a meeting was a good idea, and several assured you they would be ready to speak up. However, your first staff meeting was brief. When offered the opportunity to air their gripes, nobody spoke.

The results were the same at your next staff meeting 4 weeks later, although in the intervening period you were again bombarded with complaints from individuals. This experience left you frustrated because many of the complaints you heard were problems of the group rather than problems of individuals.

Questions: Discussion Criticism and Discipline

1. What can you do to get this group of employees to open up about what is bothering them?

2. How might you approach the specific problem of one or more of your employees carrying complaints beyond the department; that is, “carrying tales to administration?”

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36

C a s e 4

tHe repeat offeNder

Primary Topic—Criticism and Discipline

Additional Topics—Communication; Delegation; Employee Problems and Problem Employees

“So I slipped up and made a mistake,” said chemistry technician Arnold Adams. “All that proves is that I’m human, that maybe I’m a little careless once in a while, like everybody else.”

“I can’t call your behavior carelessness,” said laboratory manager Elsie Clark. She slid a piece of paper across her desk to Arnold and continued, “I have to call it negligence, and that’s what this warning notice says.”

Arnold scowled and said, “I don’t deserve a warning and certainly not for negli- gence.” He spread his hands and added, “What am I supposed to be—perfect? I can’t make an honest mistake once in a while?”

“You can’t make mistakes like this one. The test request was clearly marked stat but you logged it in as routine and it sat for several hours.”

Arnold shrugged and said, “Nothing happened to the patient, did it?” “No,” Elsie answered, “but Dr. Baker ordered it stat because of this particular

patient’s history. Something could have happened—we’re just lucky it didn’t.” “So nothing happened,” Arnold repeated, “but I get a warning in my file? If a

warning’s supposed to be a form of punishment, how come I’m punished for some- thing that didn’t cause any harm?” Discussion Criticism and Discipline

Elsie said, “Arnold, you’re all by yourself every night at the satellite. We must be able to depend on you to process all requests according to procedure and to perform all stat work as it’s received.”

Arnold simply scowled at the warning notice as Elsie added, “And this sort of thing has got to stop. This is the fourth conversation we’ve had like this, and the most serious yet.”

“Fourth?” Arnold’s eyebrows rose. Elsie nodded. “In 3 years,” she said. “I can’t believe you’d hold some thing against me that happened 3 years ago. A

warning that old ought to be wiped out. You’ve got no business using that against me.” “I’m using it only to point out a pattern. You seem to go along fine for 8 or 9

months or so, then up comes a major problem again.”

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“Just bears out what I said before,” Arnold said. “I’m human. I make mistakes. And 8 or 9 months since the last mistake entitles me to a clean slate.”

“I can’t agree,” Elsie said. She handed Arnold a pen and added, “Please sign the form to show that we’ve discussed this. You can write out any objections or com- ments in the space at the bottom. And should we have such a conversation again, you may find that more than a written warning is involved.”

Questions:

1. Consider Elsie’s statement, “You can’t make mistakes like this one.” Is this a valid statement? If yes, why?

2. What is wrong with Arnold’s description of a warning as “a form of punishment?”

3. How would you deal with the repeat offender if you were in Elsie’s position? Discussion Criticism and Discipline