Study Guide Support Materials

Instructor Manual: Shortell & Kaluzny's Health Care Management: Organization Design and Behavior, 7e Chapter 1 Page 1 © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.Study Guide Support Materials Chapter 1 Vignettes and Suggested Solutions

Vignette: Applicant for CEO of New Health Care Organization

You are vying for the position of executive director of a new health care organization that is being formed anticipating effects from the recent major changes in health care payment regulations enacted by Congress.

1.Describe what overall management school approach you will recommend for the new organization and why such a form is best suited to meet the changes.Open systems and resource dependence theories can be used best here because of the indeterminate nature and large magnitude of the changes. There is a need for rapid adaptation to resources beyond the organization’s control.

2.During the course of your interview you are advised that a competing candidate has recommended a totally different approach that would be inconsistent with yours if implemented in the same organization. Defend your initial position or reconcile the two.(The selected approaches may be chosen by the instructor or student).Presume your competitor has proposed the classical school of administration. You will counter with problems that will arise from the rigidity of such an approach. Suggest that some clearly defined portions of the organization may be subject to such classical administration due to their generally ministerial nature and they may be integrated into the more flexible whole you propose through open systems.

Vignette: Doctor in Conflict

You are an anesthesiologist with two decades of experience and are the head of you professional practice firm with six other physicians and numerous other highly trained and skilled professional assistants. The executive director of the hospital where you and most of your associates practice is proposing to set policies that will, in your opinion, severely restrict the collegial atmosphere physicians have enjoyed. While your first impulse is to “pull rank” on this non-physician executive director, you decide to propose methods from various schools of management in an attempt to appeal to her managerial background.

1.Select two or more different management school approaches and explain how they can be used to obviate the need for the intrusive policy changes proposed.Shortell and Kaluzny’s Healthcare Management, Organization Design and Behavior, 7e Lawton Burns, Elizabeth Bradley, Bryan Weiner (Instructor Manual, All Chapters. 100% Original Verified, A+ Grade) 1 / 4

Instructor Manual: Shortell & Kaluzny's Health Care Management: Organization Design and Behavior, 7e Chapter 1 Page 2 © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.Point out that the contingency theory of leadership allows for a choice of leadership style depending on key situational factors. This opens the way for recognition of the physicians relating in less rigid manner than other portions of the organization. Suggest that institutional theory recognizes the need to adapt to normative pressures from the environment, and that physicians have for centuries established norms that effectively require collegial environments.

• Three of the physicians in your practice are not opposed to the policies proposed and make

clear their intent to actively support the executive director. Describe how you, as head of the firm would use methods from various management schools to deal with this conflict.Recognize your colleagues’ desires to conform to the executive director’s proposed policy, but point out the need for a less bureaucratic and more open system and organic approach for the more turbulent environment of the art and practice of medicine. Remind them that physicians are faced with complex decisions often having less factual information than would be desired and that providing an organizational ecology favoring diversity will foster more creative and, potentially, more nearly correct decision in such circumstances.Overview of “Additional Debate Time” Material

Debate Time: Single Payer Game Changer

Current proposals for changes in the U.S. health care system include measures to institute a single payer approach where basic medical coverage for everyone is provided by a federally mandated single payer.While many consider this to require the government as the single payer, some countries have established other entities to administer payments. Regardless of the characteristics of the single payer, the institution of such a system will have a profound effect on operations of all medical providers.

• You are the office administrator of a large and rapidly growing private physician practice

with thirty physicians and fifty additional medical professionals including nurses, physician’s assistants, and specialized therapists. Your non-medical staff consists of seventy managerial, clerical, and facilities persons. Through attending seminars and reading current reports from experts, you have determined that institution of a single payer system will reduce the need for back office personnel handling third party payer claims by at least seventy-five percent.The growth of your firm is such that you believe you can retain current employees by transitioning them into the growing areas. What managerial approaches do you believe would best adapt to such a profound change and why?Clearly there is a need to move away from the tightly controlled classical bureaucratic form; everyone must be prepared to change and retrain as effectively as possible.Accomplishing this change will depend on an organization-wide cooperative effort. The social network perspective provides by fostering linkages among people with differing experiences and skills. Those previously immersed in third party payer issues will be 2 / 4

Instructor Manual: Shortell & Kaluzny's Health Care Management: Organization Design and Behavior, 7e Chapter 1 Page 3 © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.introduced to various other issues by those already proficient in such areas. The variety of experiences tends toward the creativity of heterophily. As time goes on and new positions are created and learned new team will be formed with cohesive homophily assuring reliable performance of routine tasks.

• You are the CEO of a service provider to the medical community. Your firm’s service is taking

over all the “back office” tasks required to process third party payer claims thereby relieving your physician and hospital clients of the costs and complexities of such claims. Your firm has been highly successful in this enterprise, but the move to single payer threatens your existence. What managerial approaches can you use to weather this coming storm and emerge as a servicer to health service providers in this new world?You’re faced with a potential enterprise destroying disaster unless you act calling in all ideas and cooperation available in your people. Here the human relations school shines. It is in the best interests of all to determine the future of the firm and determine it quickly.Develop the intrinsic motivations of creation in your staff and steer them from the specter of the destructive consequences of losing the entire business due to the extrinsic changes in third party payment methods. Move the concept of the firm from being an “insurance claim fixer” to that of a servicer to health care organizations for whatever those organizations need. While you are directing them to the creative products you want (theory X) you are primarily supporting their human needs for involvement and meaningful work (theory Y). Thus you are also utilizing contingency theory.

• You are the government executive in charge of implementing the single payer program

throughout the U.S. What management structure will you institute to meet this new environment and why?Government is, justly or not, often thought to be a prime example of rigid bureaucratic management. Your assignment is to totally banish that in your new administration. Adopt a system perspective establishing social networks incorporating health care providers, patients, government agencies, and the media to ferret out many approaches and solutions to problems as they develop in your new organization. High speed communications technology will enable you to detect trends of success, criticism, and failure early on and modify your approaches as experience dictates.

Debate Time: Unionization

Medical professionals, especially nurses, are organizing throughout the U.S. in reaction to continual cost-cutting measures and declining desirability of working conditions. Labor-management issues are becoming quite large in the health care world.

• What forms of management would you use to deal with this rise in union influence? 3 / 4

Instructor Manual: Shortell & Kaluzny's Health Care Management: Organization Design and Behavior, 7e Chapter 1 Page 4 © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.Do not, under any circumstances, attempt to “union bust.” This will backfire and worsen the situation. Instead adopt strategies that will recognize the workers’ desires while still enabling your organization to function in an economic fashion. This is, fundamentally, a human relations arena and the human relations school approach is the appropriate choice.

• Considering the various management approaches available, how would you involve unions

in your management structure to encourage cooperative relationships? This is not as farfetched as it may sound to ears in the U.S. In Germany, a large number of workers are members of unions and union representatives hold up to half the positions on corporate boards. In the midst of the Great Recession starting in 2008 Germany has been, along with China, the leading economic engine of the world.While it might seem tempting to follow the German model, the U.S. is probably not ready for such a major shift now. Time will tell if Germany or others will prove the efficacy of this approach for the long term in so telling a fashion that the U.S. will have to follow. For now, provide an environment allowing smaller changes involving union participation based on the organizational ecology model. Those that work will be selected. Establish a number of such changes so diversity will show the best while the number and small size of each will prevent major overall changes until adequate testing takes place.

• You are the head of the largest nurses’ union in the U.S and knowledgeable about the

profound differences between your 21 st professional union and the “classic” unions of the 20 th century. What management approaches would you use for your union to insure your members are adequately represented, compensated, and recognized in the 21 st century health care world?Unlike the enterprise where your members work, you’re organization doesn’t have the option (real or imagined) of operating without the other. Without an employer there is nothing to unionize. So, you want to establish a “win-win situation”, a “both and” following the open systems model. The Managerial Grid designed by Mouton and Blake (http://en.wikipedia.org/wiki/Managerial_grid_model) can provide a graphical view of this approach. The X axis illustrates concern for people, your interest in the union. The Y axis illustrates concern for production, the interest of their employer. The optimum arrangement is high concern for both people and production, and your efforts strive to drive your relationship with the employer in that direction, the 9,9 position, a position where everyone, individuals, the employer, and the union feel they are constructively involved in the enterprise.

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