Cases 31, 45, 61

Case 31

Ghost Posting in the OR

Discussion Question

1. What are the main facts of this case?

The main facts in this case show that a register nurse in the OR discovered how Dr. Neuer’s is using techniques that are so detrimental for the hospital just because he wants to protect his block time. In addition, others surgeons who are part of the organization have noted that although the OR is usually empty, they have to go to others institutions to perform their surgeries. Furthermore, Dr. Neuer uses imaginary patients to fill in the time and availability for the schedule days in which he has to post certain surgical cases. The RN communicates all this matter to the administrator in charge of the OR. After further investigations, it is concluded that Dr. Neuer does not want anybody to know how is performing his job with inefficiency. While Dr. Neuer continues doing this practice, the hospital will be financially affected.

2. Which theory or theories do you believe best explain Dr. Neuer’s behavior?

Bureaucratic theory can be used to describe Dr. Neur’s behavior in some ways. Despite all the matters going on with him, there was not flexibility for others staff members to use the OR. Another social factor that influence Dr. Neuer’ behavior might be his knowledge on how the organization does not have a clear understanding on what “constitutes adequate patient information to post a surgical case.”

3. What are the three potential obstacles to changing Dr. Neuer’s behavior? Should action (s) be taken against Dr. Neuer?

The first and most important obstacle in this case is the lack of organizational skill from the managers and supervisors in charge of the OR. First of all when management an organization there should be a clear understanding on what and how services are practice or delivery. Therefore, not being able to identify the rules established for the department would constitute a barrier to change Dr. Neur’s behavior.

Using imaginary patients could be another problem to change Dr. Neur’s behavior because it is hard to identify whether he is lying or not.

Another potential factor that can be identified in this case is the lack of human and conceptual skills from Dr. Neur’s that disallow him to care for the organization’s goal. Actions must be taken against Dr. Neur. To start with, if nothing is done regarding this matter, the organization is not going to be able to success at longer term; since both production and finance are affected.

4. What are some ways that block time can be allocated to ensure the OR is used as efficiently as possible? Who should be in charge of this process? How can the process prevent ghost posting?

One way that should improve the block time allocation is set up a carefully plan from top managers that would allow them to deliver and revise all the activities that each surgeon performs. In addition, having a clear understanding on what “constitutes adequate patient information” also will be an excellent tool that would allow the organization to achieve efficiency. Furthermore, in this case there are other ways that would allow block time to be allocated in a proper manner to ensure that the OR is used effectively. For example, instead of leading Dr. Neuer’s to use the OR by himself; make him to practice with a group of surgeons. That way he is not going to be able to lie because others doctors would see who is there in reality. It can be stated that the person who should be in charge of this process, is the individual who deals with posting notices in communication with the top supervisor from that specific department.

5. What steps can you take to ensure against this practice in the future? Provide your reflections and personal opinions as well as your recommendations for what could have done differently in this case.

One of the most important steps to follow in any organization is to have effective managers, who ensure that each staff member understands the organization mission and vision. When managers dot no set up clear rules, usually employees take advantage from that. To confirm that these types of practice do not happen in the future it is better to monitor and track so often the surgeon’s activities in the OR. Putting priority on those surgeons whose block time utilization has decreased also will help. Furthermore, establishing meetings between surgeons and supervisors is another way to improve block time allocation. Through these meetings they can communicate one another and study the areas of development for each surgeon. One thing that should be done differently in this case is to have the rules clearly established so that any surgeon could not take advantage from that.

Case Study write-up

Ghost Posting in the OR

1. Background Statement

The case of the “Ghost Posting in the OR” is a case that shows the importance of having set up a plan in any organization. Managers and supervisors should ensure that employees understand the rules established in any department in a proper manner. One of the major concerns in this case study is that the person in charge of the OR does not show clear instructions on “what constitutes adequate patient information to post a surgical case.” this case shows that Dr. Nuer’s schedule utilization in the OR has not been improving. Instead he was using imaginary patients to fill in the block time. In addition, the day that the surgeries were supposed to be performed he maintained either that patients were not showing up or that they canceled at the last minute. The register nurse has notes Dr. Neur’s behavior, and therefore, she communicates this matter to the administrator of the hospital. Investigation were made about what was going on with Dr. Neuer’s and from that it was concluded that he just used this technique to protect his block time.

2. Major Problems and Secondary Issues

One of the major problems in this case study is the ineffective organization from top managers and supervisors to establish understandable regulations for a certain department. Not being able to identify the responsibilities of surgeons is a major problem because when dealing with patient’s care it is so important that both surgeons and administrator communicate, plan and organize. In the majority of cases, major problems leave to others issues that are so detrimental for the organization. For example, in this case, Dr. Neur’s behavior affects the organization financially. Also other surgeons may feel uncomfortable because despite that the OR is empty; they have to go to other hospital to perform their surgeries.

3. Your Role

As the administrator of the hospital, the first think do in order to maintain efficiency is to let employees understand each rules established in a given department. Make sure that they follow the guidelines accordingly and examine task performed by surgeons is another way to achieve productivity. Ensure that employees would keep in mind what they have to do and how to do it is going to be an important step in the organization plan.

4. Organizational Strengths and Weakness

One of the weaknesses that administrator in the hospital shows in this case study is the unclear perception on how to post a surgical case. In addition, one area of development that Dr. Neur should work is to understand that an organization exist for a matter and to serve certain communities or individuals. If a surgeon does not improve performance, his practice experience would not be effective. This can leave to serious consequences such as decline nonproductive operating room, unemployment, and decrease on clients. Furthermore, not everything in this case study can be seemed as wrong. Some strength can be identified as well. For example, the attitude that the register nurse took towards Dr. Neuer in which she communicate the administrator of the hospital what was going on is an organizational strength.

5. Alternatives and Recommended Solutions

One alternative solution to address this matter is to organize better how the rules are stablished in the OR department. By doing this managers and supervisors should communicate and try to figure out an effective planning to ensure that surgeons are accomplishing their tasks. Communication from managers and the person who is in charge of the posting play an important role in this case study. Therefore, having knowledge and accountability of surgeons activities would constitute another alternative solution to improve performance. Finally, do not let Dr. Neuer to work along in the OR. Instead allow him to work among a group of surgeons who practice together.

6. Evaluation

When managers in an organization are not able to present their rules clear, it is hard for them to get effective productivity. Setting up guidelines among departments and employees as well, would allow the business to flow effectively. In addition effective communication between managers, supervisors, and regular employees should be essential in a business, especially when dealing with patient’s care. If proper services are not rendered, not patients will be admitted into the hospital. If no real patients got to the hospital, the organization would eventually end up going out of business.

Case 45

Nurse Bullying: Unprofessional Conduct

Discussion Questions

1. What are the facts of this case?

Raymond, a nurse in the ICU hospital, has a strong efficiency to perform his job and duties. Almost everybody notes his outstanding performance. He receives accomplishment from a lot doctors in the department and client as well. However some of sis coworkers started criticizing him because they tough that his confidentially is going beyond reality. Raymond wants to build an excellent relationship with his coworkers. But they were bullying behind him. The need from Raymond to be part of his coworkers, allows him to make the mistake of telling them some personal information that at the end harms his ethical view by the whole department.

2. What is the nature of organizational behavior problem?

The nature of this case study shows that in many cases employees get jealous from other employees. Raymond as a nurse is a top performer who basically wants to get along with all the staff in the ICU, especially the most popular nurses. However, because bullying to Raymond was so strong, he was not able to have a personal success at a longer term.

3. Which theory or theories do you believe best explain the behaviors of Raymond’s coworkers?

Since Raymond has the capacity to perform both leadership and management tasks as well; some coworkers may see him as a threat for themselves. In addition, Social factors such as Raymond’s selection from the nurse manager to be in charge of the ICU may be considered as a social theory that describes Raymond’s coworker behaviors. Using isolation or exclusion to Raymond might allow the nurses to have better satisfaction among them.

4. As the nurse leader, what interventions would be useful in dealing with workplace bullying?

The first thing to considered as an intervention to fight against bullying in the work place; is that when hiring new employees managers should make sure that each individual is capable to well deal and manage demographics variables. In many cases: race, ethnicity, sex, work experience, and professional level tremendously influence bullying among coworkers. In addition, managers and supervisors always need to be on top of their employees, making sure that a respectful work environment is maintained around staff members.

Creating workshops or specialize programs that educate nurses on how maintain and develop a positive attitude in the workplace is another way that should work to fight against bullying.

5. What types of workplace behaviors define bullying?

The first workplace behavior that defines bullying in this case study is the way that Raymond’ coworkers criticizes him behind his back. The unethical way on how the most popular nurses presented Raymond’s email conversations to the whole staff in the ICU is another behavior that defined bullying in the workplace.

6. Have you ever experienced or observed workplace bullying? Describe what happened and how is managed?

A lot of people either have experienced or observed bullying in the workplace. I have my own personal experience. When I first started working about five years ago I did speak English very well. Since I had a heavy accent, two of my coworkers make fun of me every time I spoke. After this happen over and over I ended up isolating myself from them and my other coworkers as well. For me this was not a good experience. I felt so depressed and I did not want to talk with anybody. My fear that other coworkers would do the same to me allowed me to quick the job. I that time I did not know how to handle these type situations. I was not able to find anybody who advised or help me how to manage bullying in the workplace.

7. How does bullying impact workplace moral? Productivity? Patient care? Can you think of other effects of bullying in the workplace?

Workplace moral is influenced enormously by bullying. When an employee is bulled, he or she might end up leaving the organization because no one wants to be in a place where social isolation, mistreatment, and personal attacks are consistent. All these factors would allow either a department or employees to have poor or low moral standards. Furthermore, decrease in productivity is usually guaranteed in a department when employees are bulled. For example: in this case study can be inferred that the way that specializes nurses in the ICU department acted to gain control or have dominion over Raymond’s; allowed him to ended up decreasing his productivity. Some of The factors can be considered psychological and therefore can affect his efficiency in the department. Besides all the issues mentioned before; another detrimental effect that bullying lead in the workplace is the ineffective quality on patient care. Nurses who are bulled can become emotionally untestable. Also they can make errors when admitting medication to patients.

8. How does leadership or management team contribute to bullying?

Managers or leaders who do not influence and encourage their staff to do get better, is a way of contributing with bullying in the workplace. Sometimes some employees do not realize that they are deteriorating another coworker with their comments or critics. In addition, other factors that contribute to bullying from managers and supervisors in the workplace are not allowing everyone to participate in team conferences; also to showing care about what they say.

9. What types of ethical issues are identified in this case study?

One of the major ethical issues identified in this case is the way that Raymond’s coworkers embarrassed him in front of the whole ICU department. Showing out the conversation maintained between Raymond and the secret admirer, who was one of the nurses who planned the prank, was morally wrong from her. In addition, Raymond behaviors are considered unethical in some occasions. As a professional the individual always should maintain high standards in any organization. This includes not sharing your personal live with a coworker just because you want to get confidence from her.

10. What kind of financial impact do you think the behavior of the nurses and their supervisor may have on the hospital?

Misbehavior from nurses and supervisors affect the finance of the hospital enormously. The first issue to consider is the decrease in productivity. When a staff member does not perform the task properly, someone else may have to do it. In addition, if nurses are distracted by some factors such as bullying, they may not delivery an adequate quality care to patients. If this happen the hospital would have a decrease of patients coming in and therefore its finance would decline as well.

11. Provide your reflections and personal opinions as well as your recommendations for addressing this problem.

Bullying has become a major problem in the workplace nowadays. By examining this case study it is more than clear that sometimes top performer employees make mistake due to social isolation. It is sad to see that somebody who is capable to influence, lead, and organized could not be able to gain popularity in a specific department. When managing an organization, administrators should always make sure that employees are not perceived as overconfidence from others coworkers. Also educate their staff members, establish rules or regulations, and assign task to everybody despite their popularity. All these decision making should be based on their experience and knowledge about the subject. In addition, dividing the tasks and responsibilities in a fear manner among employees in a specific department would help to get better outcome for the organization and employees as well.

Case Study write-up

Nurse Bullying: Unprofessional Conduct

1. Background Statement

This case study shows how bullying is affecting the workplace enormously nowadays. This is a major concern that a large number of Organizations such as hospitals deal with it. In this case study Raymond, who is a nurse in the ICU department in a hospital, is bulled by his coworkers. As it is stated in the case, Raymond is a person who delivery woo quality services to his patients and coworkers as well. In addition, he is well prepared among the other nurse practitioners in the department. Raymond possesses a strong leadership personality. He is always answering questions, helping others, and taking excellent care of the physician’s patients and their family as well. Raymond is admired by the majority of people among his job including, doctors, patients, and other staff members. He is always trying to build an excellent relationship with popular nurses, who are his coworkers. However, despite all his excellent performance, he is not able to gain popularity from the most them. Although he is a top performer, his behavior leads to be interpreted as “overconfident and conceited.” Therefore, some of his coworkers commit immoral and unethical issues with him that enable him to end up socially exposed in front of the whole department.

2. Major Problems and Secondary Issues

One of the major problems in this case study is how some of Raymond coworkers influenced him to end up breaking his moral ethics. Bullying in the workplace is major a problem that in the majority of the cases lead to others issues that affect any organization at either short or longer term. In addition, as manager of any organization, the individual should take into account that when tasks and responsibilities are divided, there is usually a better outcome. It can be argued that this could influence popular nurses to misbehave against Raymond; since the nurse managers usually “put him in charge of the ICU department. A secondary issue in this case study is the way that Raymond acts in order to gain confidence from his coworkers. Whenever a person is working in any department, he or she should maintain personal business a part. The reason for this is that never is known who can damage your excellent record just because they feel jealous.

3. Your Role

As the administrator of this hospital, the manager’s role will be to establish meting or workshops more usually to educate employees on how to deal with the bullying issue. The next step to follow would be to establish clear guidelines that monitor and guide each employee through in a daily basis. Everybody must obey and follow the directions established under each department. Otherwise they would face serious consequences such as fines, lawsuits, and unemployment. Finally, work assignments are going to be dived with equality, responsibility, and proper manner in which the majority of the staff members feel confidence and happy as well.

4. Organizational Strengths and Weakness

One weakness from the organization view is the way that the nurse manager monitors his employees. It is true that bullying occurs when the bosses are not presented in the majority of the cases. However, as an administrator of an organization like a hospital, being on top of staff behaviors should be one of the main subjects that mangers address. In addition, this case study also shows its strengths in many parts. For example: having a nurse who possesses the majority of quality to deliver excellent patient’s care is awesome; since this would allow the hospital to accomplish its short and long term, to become successful.

5. Alternatives and Recommended Solutions

One alternative solution to deal with these types of issues in the workplace is to examine what are the facts that are causing the bullying. Once supervisors are aware of what it is going on they can try to meet with each employee in private to ask or listen to questions, concern, and suggestions. Then a good idea will be to establish a meeting where everyone can engage in discussions to resolve conflicts such as Blame from others coworkers without factual justification. Furthermore, as a top manager the individual has the power to make and establish rule in an organization. Therefore, a manger can come out with anti-bullying regulations. Under this rule, managers can involve voluntary employees who disagree with it to help them carry out the policy.

6. Evaluation

Being on top of what is going in a specific department should be one of major goals that managers carryout in any organization. Most of the time arguments and disagreement surge between coworkers. Having the ability to deal and resolve conflicts like bullying is a major accomplishment that administrators at all level should have. When there is no control or rules over staff members they usually tend to take advantage from that. These little issues can lead detrimental consequences to employees and the organization as well. Creating a work environment where everybody feels comfortable and happy is a technique that supervisors also should use in order to maintain excellent quality services.

Case 61

Mini-Cases for Diversity

Discussion Questions

1. What are the known Facts in each of these scenarios? What else may be going on what culture differences might explain the misunderstandings in these cases?

In the first cases the facts known are that a Spanish woman is found to have a serious breast cancer. The patient is admitted immediately to the hospital as a long as the illness is discovered. The patient does not speak English. Therefore, an interpreter explains to her the procedure to follow in order to cure her breast cancer. Although she signs the informed consent form, she gets really upset when she finds out that her breast has been took off.

In the second case, the facts identified establish how a woman is having a “painful vulvar varicose veins.” The woman already has 10 children. The woman visits her physician to figure out what are the causes that provoke incommodities in her vulvar, and how she can avoid having that again in the future. The woman husband stays with her while the physician performs the examination. The care provider explains to her that one of the main causes that lead to these types of illness is having children. Therefore once she decides not to have any more children, she will be fine. The woman’s husband gets upset and tell the doctor that she does not have any authority to decide on the number of children that they going to have.

The facts in the third case describe how patents are distracted by hearing others patients arguing. In this mini-case, there is a patient who hears shouting coming around from other patient’s bedrooms. A nurse comes to finds out what is going on and realizes that the elderly patient is having “a shouting match with his son.” When the nurse tries to call them down, they reaction was surprising. According to them there was not distraction to others patient because they were having a conversation.

The fourth case shows how languages barriers interferer in delivering communication appropriately. In addition, in this mini-case, there is a little child who is admitted in to a communal hospital. The family’s child communicates to the nursing staff that their child is “deaf.” The nurses get an American Sign Language interpreter who assists them to have a better communication. When the interpreter tries to communicate with the child, it seems that he does not understand anything he is saying. After not having any positive outcome, the nurse and doctors decide to get out of the room. By accident, one of the nurses makes a sound with a tray that fell on the floor. When the child hears it, he turns his head around.

The fifth and last case shows that in many circumstances different ethnicities affect the workplace. In this case, a Spanish woman is hired to work in the “safety initiative hospital.” The woman tries to let her administrative assistant, an African American woman, knows what she wants from her. However, the assistant does not pay attention to what her new boss says. In other words she does not do the task assigned to her nor follow directions.

2. What organizational behavior problems do these cases illustrate?

This mini-cases show that understanding language and ethnicity among employees play an important role in any organization. In addition, one of the organizational problems in these cases is that whenever there is a problem, no managers appear to deal and handle these types of situations. Another organization problem that is among all this cases is the lack of planning from managers; since they should know that they are exposed to different culture diversities.

3. What ethical dilemmas do these cases demonstrate?

One the most important Ethical dilemmas in the majority of these cases, is the need for a well understood communication. Although in the majority of the cases interpreter are provided, there are barriers that do not allow the message to be transmitted efficiently.

4. What are the responsibilities of the hospital to the Hispanic woman and the “deaf” child?

For this case, it can be argued that according to the information provided from the child’s family, the responsibilities of the hospital are well delivery. However, since it seems that the child is able to hear, the caregiver’s responsibilities are to perform as many exams as they can to figure out if the child is really deaf.

5. You are the Risk Manager in the rural hospital with the Hispanic woman. What should you do about this complaint?

The risk to the new Hispanic woman employee in the rural hospital is that having an ineffective assistant, she might not be able to perform the organizations goals. In addition, dealing with a person who does not follow rules is a real problem, especially when starting a new job. Therefore, as a new employee, if the individual sees that his or her assistant do not want to do whatever it supposed to be done; tries to communicate with the assistant in a proper manner. If the assistant do not change the way of acting, then speak with somebody a higher level who can intervene in this matter.

6. Was the physician insensitive to the pregnant woman and her husband? How could she have managed this situation differently? What should she do now?

When physicians communicate any information to patients, they have to be carefully on how to express their thoughts and to whom they refer as well. In this particular case, it can be argued that the physician was not insensitive to the pregnant woman; what really influences the misunderstanding from the couple was the fact that they already have ten children. Therefore, they misinterpreted the words from the physician. One possible solution that the physician can used is to explain the couple that she was not trying to interfere with their personal life; what she is trying to do is to explain them things in a manner that they can understand what is causing the problem. If they still angry the physician just might apologize to them and respect their way of thinking.

7. What should the nurse say to the Iranian family now?

As a managers or administrators, an individual needs to act professional. Therefore, the nurse should say to the Iranian family that she understands their discussion but that for the wellbeing of other patients and themselves it would be of great appreciation if they maintain their discussion just between them.

8. What principles of power and influence are at play here?

There are some powers that influence these mini-cases enormously. Some examples are the decision making from the nurses and physicians in many occasions. Influence of power between diverse backgrounds play a central role when dealing with manager’s care in the health care system. Furthermore, decision making and planning are essential in order to maintain satisfaction and well communicate with patients.

9. What should the managers do in each of these situations? Provide a rationale for your response to each situation?

For each of these situations manager should well prepare with an organizational plan that deals with staff members at different level. Also planning for these types of situations would help care providers to deliver excellence when dealing patient’s care. When managing hospital managers should always keep in mind that because they open the door to different communities; they would plan and organize a head of time on how to deal with different events.

Case Study Write-up

Mini-Cases for Diversity

1. Background Statement

These mini-cases point out that clear communication plays a central role when dealing with patient’s care. There are situations that caregivers may believe that they communicate with all the patients’ equality. It is clear that physicians have to give information to their patients. Every person is different. Therefore, they have to take into account the circumstances and way of act of each patient. When a patient cannot express directly to a doctor what the problem is, misinterpretation of the matter can easily occur. Language barriers can be considered as one of the most important concerns that managers should work on it.

The first case shows that a patient is admitted into a hospital to receive a breast cancer treatment. The patient and the physician do not speak the same language. An interpreter is provided to translate. After providing information to the patient, she signs the consent form. However, when she finds out that her breast is cut off she is gets so angry.

In the second case a woman visits her physician to finds out a cure for a pain that she has. The woman already has ten kids. Her husband stays with her in the examining room while the doctors observe her. The doctor tells the patients the causes of the pain, which is due to their pregnancy. The patient’s husband gets angry and tells the doctor that she has no right to tell them how many children they are supposed to have.

The third case presents how a patient and her son have an argument while they are in admitted into a hospital; since they are disturbing other patients, the nurse comes in and tell them to quiet down. They show a surprised face because according to them there is no argument, they just having a conversation.

The fourth case describes an African American family who take their son to a communal hospital. According to them, the child d is deaf. An interpreter is provided but the child seems to be loss on whatever the interpreter communicates to him. After the Physician and nurse see what is going on, they decide to go out of the room. When the nurse is on her way out she makes a sound with a tray accidently. The child turns his head around to see from where it is coming from.

The firth and last case describes Hispanic woman nurse who is going to start working in a hospital. The nurse assistant is an African American woman. The nurse assigns task to her but she does not do it although the nurse wants then as soon as possible.

2. Major Problems and Secondary Issues

One of the major problems in the majority of these cases is the way that administrators train their staff to accomplish the organization goals. When delivering services related with health services, care providers should understand that effective communication between they and their patients it is essential in order to get satisfaction. If can be inferred that one of the major problems in these mini-cases is the unavailability of getting effective communication and cultural disparity as well.

3. Your Role

As a manager of an organization the individual’s role will be to come out with possible alternatives on how to train the staff members to communicate efficiently; taking into account each individual personality. Of course these steps will involve meetings to discuss and address the major problems and advisors who train the whole organization as well.

4. Organizational Strengths and Weakness

Organizations in these mini-cases show that one of the main weaknesses is the lack of providing clear communication standards. Caregivers should be careful when communicating with their patients. If they see that something is misunderstood, they should use strategy management that would help them to improve their quality of services. Furthermore, one of the strengths identified in these mini-cases is that although there is not effective communication, whenever is need, interpreters are provided.

5. Alternatives and Recommended Solutions

For alternative solutions one of the steps to follow as a care providers is to be more than carefully when expressing a message. Planning and organizing ideas to develop effective communications should be one excellent alternative idea.

6. Evaluation

Planning in advance is a number one tool to deal with problems related to diversity. Managers and supervisors at all level should prepare their employees to interact with different personalities. In addition, the majorities of these mini-cases show that there is neither physical nor emotional abuse to the patients. However, many factors such as misunderstanding and interpretation of communication lead to unsatisfactory experience to the clients.