Manager

CASE STUDY-  Instructions:

Read thoroughly the case Beth Israel Hospital. A pdf file version of the case is also attached below along with the case review form.

Use the Case Review Form attached and formulate your response to the case.

Hint: The individual manager, in this case, is Joyce Clifford – the director of nursing who instituted the major structural changes described. She approached the situation from the point of view of the nursing staff. When viewing the case from the organizational point of view- are there other factors that should be considered?

Complete the assignment and submit the filled-out form to the file upload area of this assignment.

Assignment #:               Company:

Your Name:

Date:

The task here is to use Frame Theory (Bolman & Deal) to diagnose the situation, recommend actions for the individual manager, and diagnose problems in the company. You want to respond to all the bold sections below.

1. What is the scenario (what is going on?).

Analyze the situation from each of the four frames.

1. Structural Frame
2. Human Resources
3. Political Frame
4. Symbolic Frame.
5. What options are available to the individual manager in the case? Consider these from each of the four frames
6. Structural Frame
7. Human Resources
8. Political Frame
9. Symbolic Frame.
10. From the perspective of the whole organization:

What are some of the diagnostic clues that things are not optimal or signs of organizational dysfunction?

Some examples of dysfunction can be: Lack of trust; Too much or too little conflict; high turnover rate; increased complaints.

What is the balance among the four frames? This can be seen as the Problem. If one or two frames are being paid a lot of attention to and the others neglected, that can be problematic.

Note:  Simply emphasizing one frame over another by a particular company is not necessarily bad. However, if the imbalance results in some sort of trouble signs (Bad PR, Loss of $$; Loss of Good Will; Key employees leaving, lower stock value, etc.) then that is a different matter. The company exhibiting serious trouble signs would be in the Unhealthy category.

 

5. Your recommendations:
6. What course of action should the key person in the case follow, given the present situation?
7. Imagine yourself a management consultant giving advice to the firm as a whole: what should they have done? What should they do now?

Please pay equal attention to both the above questions. In the first part, the individual has to deal with the current situation – what should he/she do?

In the second, you can address questions related to what should change in the organization as a whole.

 

Beth Israel Hospital Case #2

B E T H  I S R A E L  H O S P I TA L

 

Boston’ s Beth Israel Hospital is a restructuring effort in health care that sought to move toward greater autonomy and teamwork. When Joyce Clifford became Beth Israel’ s director of nursing, she found a top – down structure common in hospitals:

The nursing aides, who had the least preparation, had the most contact with the patients. But they had no authority of any kind. They had to go to their supervisor to ask if a patient could have an aspirin. The supervisor would then ask the head nurse, who would then ask a doctor. The doctor would ask how long the patient had been in pain. Of course the head nurse had absolutely no idea, so she’ d  have to track down the aide to ask her, and then relay that information back to the doctor. It was ridiculous, a ludicrous and dissatisfying situation, and one in which it was impossible for the nurse to feel any satisfaction at all. The system was hierarchical, fragmented, impersonal, and [overmanaged] [Helgesen, 1995, p. 134]. Within units, the responsibilities of nurses were highly specialized: some assigned to handling medications, others to monitoring vital signs, still others to taking blood pressure readings. Add to the list specialized housekeeping roles — bedpan, bed making, and food services — and a patient witnessed interruptions from a multitude of virtual strangers. No one really knew for sure what was going on with any individual patient. With the support and cooperation of Mitchell Rabkin, Beth Israel’ s progressive CEO, Clifford instituted a major structural change, from a pyramid with nurses at the bottom to an inclusive web with nurses at the center. The concept, called primary nursing, has each primary nurse monitor the care of a specific patient. The nurse takes information when the patient is admitted, develops a comprehensive plan, assembles a team to provide round – the – clock care, and lets the family know what to expect.

A nurse manager sets goals for the unit, deals with budget and administrative matters, and makes sure that primary nurses have ample resources to provide quality care. As the primary nurse assumed more responsibility, connections with physicians and other hospital workers had to be revised. Instead of simply carrying out physicians’ orders, the primary nurse became a professional partner, attending rounds and participating as an equal in treatment decisions. Housekeepers reported to primary nurses rather than to housekeeping supervisors. The same housekeeper was assigned to make a patient’ s bed, attend to the patient’ s hygiene, and deliver trays. Laundry workers brought in clean items on demand rather than making a once –

a – day delivery. Beth Israel’ s inclusive web was further strengthened by sophisticated technology that gave all network points easy access to patient information and administrative data. Primary nurses learned from performing a variety of heretofore menial tasks. Bed making, for example, became an opportunity to evaluate a patient’ s condition and assess how well a treatment plan was working. Joyce Clifford’ s role also was transformed from top – down supervisor to a web – centered coordinator. Rather than telling people what to do, she focused on keeping everyone informed: At the center of all patient care at Beth Israel, Joyce Clifford linked the various intersecting points of the inclusive web: “ A big part of my job is to keep nurses informed on a regular basis of what ’ s going on out there — what the board is doing, what decisions are confronting the hospital as a whole, what the issues are in health care in this country. I also let them know that I’ m trying to represent what the nurses here are doing — to our vice – presidents, to our board, and people in the outside world . . . to the nursing profession and the health care field as a whole” [Helgesen, 1995, p. 158]. Beth Israel’ s primary nursing concept, initiated in the mid – 1970s, produced significant improvement in both patient care and nursing morale. Nursing turnover declined dramatically (Springarn, 1982) and the model’ s success made it highly influential and widely copied both in the United States and abroad. But even successful change won’ t work forever. Over the years, changes in the health care system put Beth Israel’ s model under increasing pressure. More patients with more problems but shorter hospital stays made nurses’ jobs much harder at the same time that cost pressures forced reductions in nursing staff. Beth Israel chose to update its approach by creating interdisciplinary “care teams.” Instead of assembling an ad hoc collection of care providers for each new patient, ongoing teams of nurses, physicians, and support staff were created to provide interdisciplinary support to primary nurses (Rundall, Starkweather, and Norrish, 1998).