Short Case 16: Complaining Doctor and Ambulatory Care and ...



Short Case 16: Complaining Doctor and Ambulatory Care and Case 20: Managing Relationships: Take Care of Your NursesSandra ThorsonUniversity of MaryBUS 630 Week 3 AssignmentJanuary 20, 2016Short Case 16: Complaining Doctor and Ambulatory Care and Case 20: Managing Relationships: Take Care of Your NursesShort Case 16: Complaining Doctor and Ambulatory CareThe assistant director for ambulatory services should ask to speak with the physician in a non-public area and ask him to restate his concerns. At that point the assistant director should thank him for his time, restate his concerns and schedule a time to speak with him in the near future (Scheck McAlearney & Kovner, 2013). Then the assistant director should begin to collect some information such as have the staff been reporting having issues or concerns with this physician? If this is true, is it one staff member or how many have voiced issues or concerns? Are the issues recent or how far back has this attitude been known or tolerated? Is this how the physician always behaves? An additional concern might be what the situation was the particular day the physician was complaining? For example, were all of his cases running late, did he have adequate staff and supplies or where there other situations the assistant director needs to be aware of such as a negative attitude from support staff? If the physician himself is having issues then what is his backstory? Does he have some personal issues or concerns that staff is not aware of, such as issues with a family member or even a private practice he is also trying to run? They are not excuses for this type of behavior, however, they may help to understand what may be a contributing factor to his attitude (The Arbinger Institute, 2008). There could be many factors related to his complaint. The best approach is to allow him to calm down while information is collected and agree for a future meeting.Immediately the director for ambulatory services as well as the director of nursing should be notified of the complaining physician. If he is complaining that the staff are not good then an assessment of the staff should be completed (Scheck McAlearney & Kovner, 2013). The next step would be to analyze the staff. Have they received the proper training and education to be knowledgeable in their skill set? What has the retention rate been? Do the staff demonstrate signs of unhappiness with their job or organization? Signs of unhappy employees include: employees are checking out, they are there to punch in and out, complete the necessary tasks to get the job done, however, they are not engaged or empowered in the organization; lack of a team effort such as when a usually involved employee starts to single themselves out and not engaged with the team or unit; fault finding where an employee will never claim fault with themselves, however, they are able to constantly point the finger at colleagues; employees are not held accountable; a lack of respect for authority is demonstrated among staff; employees are resistant to change and has there been an increase in patient or customer complaints (Del Buono, 2013)? Have there been any employee opinion surveys completed recently and if so what have those results been? If there were areas of concern have they been addressed? It would also be wise to consider the physician’s background. Due to the Affordable Care Act there have been several rules and regulations put into place for physicians and health care organizations which in turn have placed financial burdens on both parties. Relationships between both parties have been strained while at the same time trying to maintain the goal of efficient and safe patient care. The goals, mission and values of the physician must support those of the organization (Carlson, 2010). It may be difficult for physicians to continue to run a private practice and maintain the care of their inpatient population. Patients may be requiring the services of more than one health care provider and a multi-disciplinary approach may be necessary which may cause the physician the feeling he is losing control of his practice. Again, these situations do not give him permission to act this way, however, having some of this information may help to understand why he his feeling frustrated or overwhelmed and wanting to complain. This information may also assist with the approach to the situation.Later in the week when the physician is demonstrating that he is unsatisfied again and that this time the issue is with the assistant director, it would be beneficial that further contact should be between the physician, the Director of Nursing and the Director of Ambulatory Services (Scheck McAlearney & Kovner, 2013). It may be that this particular physician is difficult to please, however, initially he should be treated as a valued partner and does deserve to be listened to. Any areas of concern should be agreed upon and addressed immediately and in person. If the issues the physician is complaining about are invalid, he should be informed his attitude will not be tolerated. It is important that the relationship be worked out so the provider and organization can continue to provide efficient, safe and quality patient care. Short Case 20: Managing Relationships: Take Care of Your NursesIn order for Betsy Cline to take care of her nurses she must take full authority of her role as Nurse Manager. In order to do so, she must be empowered and have confidence to make decisions that will have positive outcomes for her staff. To avoid future conflict, Ms. Cline should have a strong input on top management decisions and object when a crucial decision that affects her staff is made by a different manager with no input from her. All staff should also expect to be properly educated and trained on new equipment or procedures prior to the implementation in a patient care setting. The definition of a strong leader is one who is engaged, visible, empowered and committed to the overall success of the unit, organization and staff (Spence Laschinger, Nosko, Wilk, & Finegan, 2014). Betsy is lacking in fundamental leadership skills and could be more assertive and vocal with her concerns and lack of inter-departmental communication. If she does not receive a timely response to inquiries, Betsy must be more aggressive in her efforts to follow up which may including following the chain of command and reporting her concerns to her immediate leader (Scheck McAlearney & Kovner, 2013). This is especially important since the safety of her staff and patients are at risk. An important priority for Jill is to familiarize herself with hospital polices and unit specific care standards as well as the core fundamentals of nursing. Appropriate time management skills and redirecting attention while waiting for inter-department interactions would maximize her productive as well as patient satisfaction. Jill can also utilize her direct manager in expressing her concerns with the lack of communication with the social services department as well as pharmacy. A circumvention of the social services department can occur if the work load can be distributed through the case management department to streamline the patient care experience as well as their individual workloads. Some health care organizations may have a position in place such as a house supervisor who may be available to assist in handling any unforeseen needs or issues. Ms. Cline or Jill could contact the house supervisor for assistance or education if needed. It would also be beneficial for this organization to have a nurse governance council that would reflect membership from each unit. The council could address issues that may be concerning to staff and have them addressed in the appropriate manner.A method of obtaining tracking patient satisfaction could include surveys such as those provided by HCAHPS. The responses provided by the patients would assist in identifying areas for improvement as well as successful programs in place. Results of the survey are critical as patient satisfaction and outcomes affect reimbursement (White & Griffith, 2016). Another way to obtain patient feedback would be leadership rounding on the unit. Leaders at many levels could have direct contact with the patient and staff to hear about successful accomplishments as well as areas of concern.The hospital administrator could be advised to promote effective and timely communication throughout all departments and levels of staff as well as engage in conflict resolution among managers. It would also be in the best interest of the health care organization to empower all levels of leadership and encourage inter-departmental collaboration in regards to safety and patient care (Richardson & Storr, 2010). Nurses could also be empowered by the representation of a house wide nurse governance council that could voice the concerns for the nursing staff. All staff should be aware of the chain of command and feel comfortable in their positions to voice concerns when appropriate and needed. The nurse acts as a patient care advocate and should take responsibility to ensure the supplies they need to provide excellent patient care are available and within easy access. Retaining key members of staff on all levels in building a strong and efficient care team.ReferencesCarlson, G. (2010, May/June). Is the relationship between your hospital and your medical staff sustainable? Journal of Healthcare Management, 55, 158-173. Retrieved from Buono, T. (2013, September). 10 Signs of an unhappy employee. Podiatry Management, 45-46. Retrieved from , A., & Storr, J. (2010, March). Patient safety: a liteative review on the impact of nursing empowerment, leadership and collaboration. International Nursing Review, 1, 12-21. Retrieved from McAlearney, A., & Kovner, A. R. (2013). Health Services Management Cases Readings and Commentary (10th ed.). Chicago, IL: Health Administration Press.Spence Laschinger, H. K., Nosko, A., Wilk, P., & Finegan, J. (2014). Effects of unit empowerment and perceived support for professional nursing practice on unit effectiveness and individual nurse well-being: A time-lagged study. International Journal of Nursing Studies, 51, 1615-1623. Retrieved from Arbinger Institute. (2008). The Anatomy of Peace. San Francisco, CA: Berrett-Koehler Publishers, Inc.White, K. R., & Griffith, J. R. (2016). The Well-Managed Healthcare Organization (8th ed.). Chicago, IL: Health Administration Press. ................
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