Embracing Missions Case Study- Price is Firm

Context:

In this case, a top nursing executive in a public teaching hospital grows concerned when she encounters employees holding negative attitudes toward the establishment’s underprivileged patient population.

Elizabeth Murphy, Director of Nursing at Oakridge University Hospital, cannot wait to get off of her feet for her lunch break. It has been a very busy morning, she is hungry, and she desperately is in need of a moment to catch her breath. On her way to the cafeteria, she navigates around and through several construction areas placed throughout the massive 525-bed public teaching hospital, located in Hamilton, a city of 1,328,984 situated in the East South Central region of the United States. The minor inconveniences associated with the construction are relatively new to her and her fellow Oakridge University Hospital employees, resulting from the hospital’s efforts to upgrade a number of patient waiting areas, repaint several main corridors, and make a number of other functional and aesthetic enhancements. Ultimately, through these upgrades, the establishment hopes to improve patient access and comfort at Oakridge University Hospital.

As she makes her way into the hospital’s cafeteria and purchases her meal, Elizabeth spots two very familiar faces who invite her to join them for lunch. They are Sherry Graham, a Respiratory Therapist, and Bruce Faulkner, an Assistant Manager in the hospital’s central supply department. Joining them at their table, she eagerly awaits the latest news—and the topic of the day pertained to the hospital’s construction. While each of Elizabeth’s two lunch mates were pleased with the construction, noting that it would make for a better working environment for staff members, their comments regarding the benefits to Oakridge University Hospital’s patients were less sincere, something Elizabeth found to be very troubling.

Bruce questioned using hospital resources to improve patient waiting areas. He remarked that since the hospital is always full, why should money be spent to improve convenience and comfort for patients. He continued on, noting that the hospital certainly does not have to worry about customer traffic, especially as it is the healthcare provider of last resort for most patients who are too poor to go anywhere else. Sherry agreed with Bruce, adding that the hospital had no reason to fear competitors stealing Oakridge University Hospital’s patient population. She expressed that because most of Oakridge University Hospital’s patients, as Medicaid or charity cases, were not paying for their care anyway, they were not truly deserving of the enhancements being made by the new construction projects. Sherry simply could not understand the rationale for doing more for Oakridge University Hospital’s patient population.

Elizabeth, a 30-year veteran of the hospital, was dumbfounded by the views expressed by Bruce and Sherry. Arguing that all patients should be treated with respect and dignity, she responded that one of the central reasons for Oakridge University Hospital’s existence is to treat patients without sufficient financial resources and noted that this obligation is clearly expressed in its mission statement. As a mission mandate, Elizabeth conveyed that Oakridge University Hospital and its employees have an obligation to these patients, making them important and deserving of the best health care that can possibly be offered.

Elizabeth was particularly quick to correct Sherry regarding her belief that Oakridge University Hospital’s patients are non-payers. Sure, they may not have the means to open their wallets and pay for healthcare services, she expressed, but government programs provide funding on their behalf that the hospital would not receive otherwise. Technically, they are paying customers; the money just does not come from their pocketbooks.

Finishing up what turned out to be an unpleasant lunch experience, Elizabeth noted that even if Oakridge University Hospital never received a single penny from any source to pay for the healthcare costs of its clients, the patients of Oakridge University Hospital still deserve the best of care and attention. Finishing off her comments, she questioned the two, asking why they would even wish to work at Oakridge University Hospital if they did not see the value of both its mission and the rewards of serving the needy.

Returning to her office, Elizabeth reflected on her lunch experience. While she was concerned that both Bruce and Sherry embraced such views, she was particularly troubled that Sherry would do so, because she is involved in the direct delivery of care to patients. If she harbored feelings in her heart and mind that Oakridge University Hospital’s patients did not deserve the comfort and convenience of enhanced patient waiting areas, how might this impact the quality of the care that she provided?

But what Elizabeth perhaps viewed to be most troubling did not pertain to Bruce or Sherry specifically, but instead dealt with the fact that she had heard time and time again the same thing from many of Oakridge University Hospital’s employees. In prior years, she had even spoken with Oakridge University Hospital’s top administrators about the matter, seeking guidance in how she should handle what at best is an uncaring attitude regarding patients, and at worst could lead to the inappropriate treatment of patients and even death. Sadly though, the top officials did not have much guidance to offer, noting public sector bureaucracy and complexities associated with disciplining employees, especially in cases where there are no tangible infractions. Elizabeth found this to be very frustrating.

While Elizabeth always tried to educate and enlighten employees holding negative beliefs about Oakridge University Hospital’s patient population, she knew that her success at converting them was at best very limited. Thankfully, she did not view the mindset held by Bruce, Sherry, and others to be epidemic, but did view it to be prominent enough to warrant concern. And there was at least a degree of comfort in knowing that the problem was not limited to Oakridge University Hospital, as, through her network of professional contacts, she came to realize that the mindset was rather commonplace at public hospitals serving the underprivileged.

In trying to craft a theory on the origins of such a negative and unproductive mindset, Elizabeth’s best guess was that it simply was an artifact of the institution’s culture and characteristics. She well knew that Oakridge University Hospital did not possess a marketing culture; that its employees did not view themselves to be customer service agents or ambassadors on behalf of the institution. And she well knew that a constant and unending flow of patients who possessed few if any other options for medical care certainly could instill a mindset of complacency in employees and the institutions in which they served. Further, she knew that the size of Oakridge University Hospital did not help matters, as the employee base was so large that massive bureaucracy was a given, making even seasoned employees feel more like a number than an individual person. Elizabeth reasoned that all of this and more set the stage for negative mindsets at Oakridge University Hospital.

Regardless, Elizabeth could not understand why employees would care to work for an institution that embraced a mission that they personally deemed to be unacceptable. She wondered why they would not desire working elsewhere; somewhere that supported a mission they personally viewed to be acceptable. Their motives defied comprehension.

Elizabeth cared very much for Oakridge University Hospital’s patients and, given her longtime experience at the hospital, she was committed to improvement on every front. Hearing Bruce and Sherry’s perspectives brought back countless memories of other employees expressing similar views. She wondered what more she could do to improve the customer service and marketing orientations of Oakridge University Hospital’s employees.

DISCUSSION

1. This case presents a very negative mindset harbored by at least some employees at Oakridge University Hospital. What are the possible ramifications for patients at Oakridge University Hospital or any other facility who encounter employees possessing the mindset held by Bruce and Sherry? Do you believe that such a negative employee mindset can result in tangible patient harm, or is the mindset simply a personal expression that would not be extended to the care and treatment of patients? Please justify your responses.

2. Assume that you are Sherry’s supervisor and you receive a telephone call from Elizabeth who conveys the perspectives that were echoed by Sherry over lunch. Would you bring the matter up with Sherry? Why or why not? If you did indeed address Sherry, what approach would you take and what would you expect to gain by your actions?

3. Elizabeth attributes the negative perspectives of the patient population held by Bruce, Sherry, and some others at Oakridge University Hospital to be the product of culture, a burgeoning supply of patients with few alternatives, and bureaucracy. Assuming that she is correct, how might you go about stemming negative sentiment?

4. Elizabeth noted that she had approached the top executives at Oakridge University Hospital and asked for guidance as to how she should address employees when hearing negative perspectives regarding the hospital’s patient base. Much to her dismay, she did not receive any particularly beneficial advice. What does this say about the executives she consulted?

5. This case presents an account by a nursing executive who encountered a negative mindset held by at least some of Oakridge University Hospital’s employees. Suppose that Elizabeth had been accompanied by a marketing manager during her lunch meeting with Bruce and Sherry. Would you anticipate the marketing manager’s perspectives on the matter to be similar to Elizabeth’s, less intense, or more intense? Please justify your response.