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6 MAINLINERS - Havoc In The Organization

For over two years, the seventy bed Rosewood Memorial Hospital where Doug Blocher is the new interim administrator has averaged a daily census of about twenty-five. The lack of patients has resulted in severe financial problems and serious questions about the quality of care.

By his second day on the job, Doug is ready to take charge. His first action is to cut the non-medical staff by one-third. Next, he orders the closing of the second floor. The patients and staff are to be crowded into the remaining space. He directs this done within sixty days. Finally, he orders a reorganization of the accounting department with no specific instructions other than to reorganize.  Not bad for only two days on the job.

The third day, the Chief of Staff confronts Doug. "Don't you think you should have talked with me before sending out orders to disrupt everything?"

Doug looks surprised and says, "I didn't do anything to disrupt medical services. I only started some things to get the administrative operation running a little more efficiently."

The chief's exasperation shows as he says, "A hospital is a complex place. You can't start changing things without understanding how that will impact on other things. The people also have to be considered."

Doug is about to respond when the doctor is paged and quickly moves to other responsibilities. Doug also moves on.

There is a message on his desk to call the president of the hospital's Board. Doug takes a deep breath as he listens.

"What are you doing over there, Doug?"

"I'm doing what you hired me to do. I'm getting this mess straightened out."

Doug taps a pencil on his desk as the president explains, "I did not expect you to go charging like a bull your first week. I thought you would take a few weeks to get familiar with the hospital and the problems, talk to people and you know, like that."

Doug is a little exasperated too as he says, "This is no time to change the expectations just because there is a little heat. I thought you wanted things straightened out."

It is Doug's lucky day. Just at that moment, the president gets another call and has to hang up. His last words are, "We'll need to talk about this when I have more time."

Things are working out well. Doug has more important things to do anyway. There is a job to do, and he is just the man to do it.

Ruth, Doug's administrative assistant, walks into his office. She is frustrated and annoyed about something. "You are going to have to do something about this one."

Doug raises a questioning eyebrow.

"Mrs. Markov is out here and she is irate again. Her husband owns the Rosewood Bank."

Doug smiles and says, "No problem. Send her in."

Mrs. Markov's problem is that she thinks the receptionist was rude to her. Without a second thought, Doug calls the employee and orders her to report to his office.

When she arrives, Doug says, "I will not tolerate the way you treated Mrs. Markov. I'm immediately suspending you for three days. I will not put up with that." The receptionist starts to respond but Doug waves her off and says, "I don't want to hear it. You heard what I said."

After the employee leaves, Mrs. Markov says, "I did not want anything like that to happen. You were too rough with her. I did not expect you to treat her worse than she treated me. It was not that big of a deal. I do not know what to say to you, but I expect my husband will want to hear about this."

Once he is alone in his office, Doug sits at his desk, trying to figure out what happened. In the middle of his musings, his phone rings. It is the personnel director.

"Doug, we have to talk. I am still dealing with the riot you started yesterday. Now I have a receptionist screaming in my face that you violated personnel policies. Give it another hour or so and we are going to have a complete walkout on our hands."

In a rushed tone, Doug says, "You'll need to follow up on this one for me. I don't have time for these kinds of details. I have more important things needing my attention right now. Take care of it and get back with me on the status of this issue. Give me a call if I can help."

The personnel director is momentarily speechless. By the time she gathers her thoughts, Doug has hung up and has moved on to other things.

On his way out of the administrative area, Ruth stops him with another problem. "It is the reporter from the Times on the phone. She wants a statement from you about the hospital's problems and your first week on the job."

Doug smiles and returns to his office where he talks to the reporter. "As the community knows, there are some serious problems. It is clear to me, though, the difficulties are all resolvable. I have started the process of improvement. There will be those who are unhappy and do not like the necessary solutions. It is strong medicine but the medicine has to fit the problems. I have things under control and expect things to be back to normal in a few days. Those who are unhappy need to understand that patient care is the first priority. We are on our way to a better future here at Rosewood Memorial."

Doug is barely off the phone when the president of the hospital walks into his office. "Doug, I am cutting to the chase with this. Let's get to the nub of it. We need to take a close look at how you are handling this and at what other options we have. People are up in arms."

Doug leans back in his large leather chair and says, "This is not one of those times where there are a lot of options. There are only two. We can back off and let the hospital go the rest of the way down the tube. Alternatively, we can follow through with what we have started. Those are the choices."

They talk back and forth for almost an hour. Doug finally says, "It may be time to bring in a systems analyst to look at the utilization problems. They interrelate with the serious personnel problems now surfacing. There are also issues in accounting and a major public relations problem. There are also the problems with the medical staff and their resistance to change. I could have some good people in here in a couple of days. We have a real crisis here."

The president quietly says, "I knew it was bad, but I did not know it was that bad. We better do something before it gets away from us. The town needs its hospital."

Once the president is out of his office, Doug takes a long breath and presses his fingers to the sides of his head. "That was a close one," he thinks. He wonders about what to do next. "I have to do something. The worst thing I could do now would be to back off. I would loose the respect of everyone. Just do something! Poke at it enough and something will happen. What in the world do they expect? They want a miracle. Maybe I'll call someone. They may know what they are doing."

The pot continues to boil at Rosewood Memorial. Incidents keep popping off in what Doug sees as random and unpredictable ways. He sees no pattern. Nothing is related to anything.

Doug is again talking to the president. "I'm not sure how they managed to keep all this covered up for so long. I would not have believed it could be such a mess."

The president says, "Staff members are calling me. They say you are making matters worse. Is that possible?"

Without any hesitation, Doug says, "I have not changed my approach. I am handling things the same way I did from the start. There is no way to go at this but head-on. We are just getting it out into the open. I think we may have to accept the reality the hospital may not survive the neglect of the past few years. Looking for other options for medical care may be our most responsible option. At least, we have to have an alternative in the wings. Let's face it. We are talking about bad management. We just need to be ready."

Two months later, Doug is once more meeting with the president. Doug says, "We can look until the cows come home at the separate parts of the problem and at how to fix the little pieces. We must keep our focus on the big picture. It's not just a combination of little things. It's a crisis about to blow up on us. The time is here to solve this once and for all. We are just lucky I got the SRC group to help us out of this."

As a last try, the president says, "This is going to put the hospital out of business. This does not even consider the $20,000,000 the community will loose in assets and increased costs. All that is bad enough. I shudder to think about the disruption in services and the cost to the families using the hospital. Is it worth it?"

In a most conciliatory tone, Doug says, "The reality is we have no choice. It is the price of trusting people. At least, that will never happen to us again."

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Please send comments or questions to Gary A. Crow, Ph.D. GAC@GaryCrow.net