Jonathan Rosenblatt

HADM 206
Final Exam

Case A

1.
Dr. Gordon was described as a man who did not care how people thought of him; only of

results. In face of huge opposition he was able to create a whole new field of medicine,

emergency medicine. He was able to create and maintain a favorable image of himself by saving

countless lives and seemingly perform miracles. He developed strong allies and a strong based of

support that consisted of legislators, emergency personnel, and even the governor. Dr. Gordon

was able to use his political skills to get what he wanted and keep the Shock-Trauma Center

under his control.

Dr. Bradley was not as politically gifted. Instead of working with the three doctors who

apposed him, he fired them. He essentially blamed these three doctors for anything that could go

wrong instead of working with them. Dr. Bradley could have created some reciprocity to appease

these doctors rather that all out getting rid of them. Dr. Bradley would use information as a

political tool, using information about dwindling resources and the state of the healthcare

industry to support his decisions. A political tactic that Dr. Bradley did probably use was getting

rid of his detractors. By getting rid of those who apposed him he believed that he could move his

agenda farther.

2.

There are many positives to using political strategies to effect change. In an organization

that is run by the states Emergency Medical Services, it would be next to impossible to get

anything done without being close to all the key players. With a strong base of support and
powerful allies, any agenda you make is going to be accepted. Political strategies also, keep you

from opposition and keep those who might appose change content or out of the picture.

The risk in using political strategies is that they can backfire. Some strategies can make

you appear insincere or fake. Another potential negative is backlash. In the case of Dr. Bradley,

he could not work politics in the same way Dr. Gordon could. He attempted to remove three

doctors who apposed his agenda and as a result, lost the support of those who helped create the

Shock-Trauma center. Firefighters, physicians and other hospitals began to question the moves

Dr. Bradley made and affected his ability to institute change. In the case of Dr. Bradley his

political strategies, while they may have appeared similar to Dr. Gordons, failed and made him

look weak.

3.

While there may be a strong desire to depoliticize healthcare I do not think it is possible

or obtainable. Over 17% of our GDP is spent on health care, with such a large number there is no

way to make healthcare non political. In the past healthcare went largely unregulated and acted

with total independence. Doctors made decisions they felt were right and went unquestioned.

While this is a great ideal and we would assume doctors are experts in healthcare, they are not

experts in economics or the administrative side of healthcare. While healthcare went unregulated

healthcare costs skyrocketed to the costs they are now. Recent regulation and recent

politicization is working to reduce costs, but in different ways. Even in the case of the Shock-

Trauma Center, the center acted for years autonomously with no regard for cost. When Dr.

Bradley was appointed and tried to consolidate care to decrease cost and maximize resources, he

was met with backlash and resistance. White people may dislike politicization, what they really
fear is change and the unknown. Regulation often means change and change means people lose

jobs or the status quo changes and people do not like that. Politicization is annoying but

necessary aspect to the healthcare system.

4.

I agree with Dr. Gordons statement you can tell the pioneers by the arrows in their

back. Often pioneers are those who seek change. Change is not something that people are

comfortable with. It makes us scared. Often those who try to make the most change are criticized

and attacked. Steve Jobs, for example was removed from the company he founded for trying to

revolutionize the home p.c. While there were many pitfalls along the way his legacy is one of

innovation and change. Healthcare is a sector that needs the most change right now, resources

dwindling and costs skyrocketing. People who try to change the system are shut down and fought

throughout the entire process. Not every state has implemented Medicaid expansion; large

insurance companies are dropping out of the marketplace. Big hits to the affordable care act are

happening while the change process is going on.

5.

To bring about change in the trauma center Dr. Bradley could have used Lewins change

model. Dr. Bradley could have explained to those resistant to change how important it is to

reduce duplication of service and reduce use of resources. He could then have created and

revised policies and procedures and ensure those resistant to change understood them. Lastly he

could have kept an eye on the change process and made amendments along the way.

Dr. Bradley could also have used Kotters eight steps that built on Lewins change model.

This model is different in that it encourages the development and use of a vision, empowers
employees, and plans for reachable milestones. This model would most likely have been more

effective, as it moves the change process from the hands of the executive branch of leadership

down to the lower tier employees and managers. Also the doctor who apposed the change were

fearful that the original mission of the hospital would be diluted, so establishing a new vision

could help to get them on board.

6.

An organizational development strategy that could have been in making changes at Bay

State is human process intervention. The biggest issue that the new CEO faced was the history of

the physicians and the feelings that their work was more important than the change, or that the

change would interfere with their work. The new CEO also faced backlash from community

members who felt they were not included in the changes. With better communication with

firefighters and physicians, the negative press and resistance could have been reduced.

Alternatively, strategic interventions could also have been used. Physicians were worried

that the new lines of care would dilute their mission and reassuring the doctors that the new

patients would be a boon for the center could have helped reduce fears. The hospital feared that

patients might not received the best treatment, so using strategic interventions to analyze and

show how the move to treat all trauma patients at the Trauma center would actually be a good

thing.

Case B

1.

There was absolutely no communication between the various departments. Never was
there any mention of even consulting with the various doctors or even Dr. Boyer to discuss the

potential difficulties of implementing electronic EKG. Dr. Boyer, who was described as being a

valued member of the hospital was caught off guard, as well as the other doctors and nurses who

were never notified of the change in EKG reading. EKGs play a surprisingly large role in health

care and the misinterpretation of an EKG can be life threatening. Effective communication

would have notified all healthcare providers in the hospital to the impending change and

included their input in the implementation of electronic EKG.

2.

Mike Hammers leadership style relative to the attempted change was rather poor. Instead

of making the changes himself, he hired on a relatively inexperienced individual to act as the

COO and gave her a lot of power. In this case Hammer did not act like a leader, but like a

manager. In this case I would say Mr. Hammer was an impoverished manager. He did not at all

attempt to make any changes and every time he did attempt a change he allowed the physicians

to shoot him down. He had little regard for the well being of his staff and seemed to only care

about his position as CEO rather than actually making a difference himself. He thought very little

of the doctors in his hospital and as a result exhibited low concern in his implementation of

change. Even at the end of the case study, when Dr. Williams approaches Mike Miller, he brushes

it off and instead essentially tells Dr. Williams that he does not really care and is sure that it will

all be resolved in no time. In all honestly, Mike Miller probably had no idea what was actually

going on and allowed Marge to act completely independently.

3.

Marge Harding was probably unsuccessful in implementing a cost saving idea. Instead of

reducing costs and changing the culture of the hospital she did the exact opposite. She made the

assumption that she was more intelligent than all the doctors and understood how the properly

provide healthcare and made a change she believed would be beneficial. Her idea to dismiss a

doctor in place of minimum wage technicians to read EKGs electronically instead of saving

money, instead most likely cost more. It opened the hospital up to many potential malpractice

suits and diminished the quality of care the hospital provided.

She also failed in a huge respect of making small steps to eventually change the culture of

the doctors. The plan was to slowly make small changes that would lead to bigger changes. Ms.

Harding fired a beloved doctors and valued member of the hospital staff who provided consistent

quality and unwavering dedication to the patients her served. This only angered the doctors more

and showed them how out of touch the administration truly is. Lastly by Marges calculations she

was only saving $100,000, which even in the late 90s is not a large enough sum of money to

warrant such a drastic change.

4.

Harding should meet with Dr. Williams. Dr. Williams is a representative of the doctors in

the hospital and as such should be an important contact. If the goal of the Mike Hammer is to

reduce costs by reigning in physicians, Dr. Williams is the first person Harding should have met

with. She should have first gone to Dr. Williams to understand why it was the doctors were so

hesitant to make changes to the way they practice. She should have attempted to understand what

services were truly important to functioning of the hospital and then making changes based on
her finding. She should meet with Dr. Williams, not as someone who knows more or controls

more than him, but as someone who is trying to learn how physicians practice and how their

practice could become more in line with goals of the hospital.

From the way Harding is described it would appear that she would do none of this. She

would most likely come to a meeting acting as if she knows everything there is to know about

healthcare and how to properly run a hospital and instead of endearing herself and potentially

make a partner to help move her goals forward, would have most likely created an enemy. The

meeting should be structured where Harding comes to Dr. Williams with multiple ideas for

changes and seek his opinion on what have potential and what will be met with open hostility.

5.

I did not like how Mike Hammer believed that physicians just could not understand how

hospital finances worked and could not and would not reduce costs. The real reason the doctors

would not work with Hammer was because of this attitude. It was probably obvious when

confronted with the desire to change Mike Hammer approached doctors with this attitude and

there was no reason for them to have any desire to reduce costs, it probably had the exact

opposite effects and caused the physicians to become even more dissatisfied with leadership and

waste more money.

If I were in this position I would instead come to the doctors seeking to find out what

aspects to their practice was most important to them and discover what ways they could cut

costs. Even if it were just small things, the doctors would have made small changes to the way

they practice that could have positive effects. Doctors are very concerned with the care of their

patients, but that does not mean they have no regard for the costs of the hospital. The project I
would attempt is medial waste during procedures. Doctors are not responsible for the medical

equipment of the hospital and as a result are more likely to use more disposable products, such as

angioplasty balloons. A project I would implement would be to reduce the waste of balloons and

make doctors more responsible for the equipment they use during procedures.