Jl aitematve strategies? What are the concerns in using a purely quantitative sc

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Jl aitematve strategies? What are the concerns in using a purely quantitative scale of evaluation? 9. What are the responsibilities of the engaged follower? O. What kind of actions might an organization take in order to ensure sustained leadership? CASE: The New Department Director As a new director of ambulatory care at the Kennedy Medical Center, Dr. Grant, started to review issues in was clear that somethin the hospital, it g was wrong. Every day, a large crowd of patients and families waited for hours in the emergency tment. Although the outpatient ambulatory practices seemed to be running smoothly, the emergency department, wh ing they would hospital in the city because Kennedy Medical Center did s and staff to accept more patients. Dr. Grant was embarrassed by the situation and was surprised that no one higher up in the administration had noted this as a concern. When he asked about it, his boss, the chief operating officer of the within Dr. Grant's responsibility, seemed to be a mess. The hospital was typically going "on divert." mean divert ambulances from the emergency room sending them to another not have the bed hospital, said it had been this way for a while. Dr. Grant approached Ms. Downs, the nurse manager of the emergency department and a nurse with 25 years of experience at the hospital, about the issue. She also reported that the situation was no worse than usual and, while it was not ideal Kennedy Medical Center did better than other hospitals in the area. Still, the situation bothered Dr. Grant, and he made a promise to himself that he would fix it, setting a goal of having 90 percent of the emergency department outpatients in and out of the emergency department in four hours and having the emergency department be on divert no more than once per month. He was not sure what the current percentage meeting this goal was, but given his previous experience at other hospitals, he aimed to accomplish these objectives in six months. With his problem identified and clear objectives set, Dr. Grant set out to implement a new strategy, which involved (1) teaching the staff about root cause analysis, (2) reengineering the triage work flow to speed access to a clinician, and (3) making what he viewed as a minor fix to the current electronic registration system to improve team communication. This approach had worked well in his former hospital, reducing wait times by more than 30 percent within six months After much planning. Dr. Grant held a staff meeting of the nurse manager and the three emergency department supervisors who reported to her to discuss the new strategy. He described the new processes. which were supposed to smooth out

Explanation / Answer

1. The problem was that ambulatory care at the Kennedy Medical Center always had a large crowd of patients. These patients had to wait for several hours in the emergency department. This led to a situation in which the hospital had to divert ambulances from the emergency room and send them to other hospitals.

2. At the individual level, the nurse manager of the emergency department got bogged down by the initial failure of the reengineered process as suggested by Dr. Grant. At the team level, team communication required improvement. At the systems level, the triage work flow had to be reengineered .

SMART is specific, measurable, achievable, realistic and time bound.

Objectives for individual level problems: Dr. Grant should set an objective for the nurse manager to try the new workflow with different iterations (specific) and see which iteration gives the best result in terms of reduced patient wait time (measurable, achievable and realistic). All the iterations should be tried in 2 month's time (time bound).

Objectives for team level problems: Improve the team communication so that all members of the ambulatory care are at the same platform always (specific, measurable, achievable and realistic). This should be done in a month's time (time bound).

Objectives for system level problems: reengineer the triage work flow (specifc), so as to reduce wait time (measurable). Different iterations can be used (achievable) in the context of cuurent situation at the hospital (realistic). All the iterations should be tried within 2 months (time bound).

3. Dr. Grant could have avoided the situation by clearly outlining the potential limitations of his work plan to the members of the ambulatory care at the Kennedy Medical Center. Secondly, he should have addressed the limitations, recognizing the fact that managerial problem solving involves trade offs. He should have fostered support for a stratgeic direction.

4. Going forward, Dr. Grant should perform a comparative analysis of the alternatives and discuss it with the team. Evaluations will have to be done on the basis of impact on productivity, expenses, feasibility and time required. He should then prepare a quantitative rating for the different alternatives.

Dr. Grant should also develop a proper implementation plan.

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