St. Bruno is faced with the challenge of how to attain the institution’s already set objectives amidst the conflict amongst the employees. The hospital is faced with the challenge of how to form a formidable affiliation with other institutions for the benefit of the staff members. The hospital was founded and established in a religious environment. The hospital has since experienced expansion with an increase in capacity and the number of employees. The number of medical practitioners reduced over time due to tight principles laid by the veteran senior staff members. This is because of some political gimmicks that have infiltrated the Institution making it difficult for the implementation of generally accepted policies amongst professional practitioners (Locke & Latham, 1990).
The organization was set upon some loose principles that allow infiltration of immature politics amongst the physicians. The formation of the informal groups within the institution indicated the start of all the problems. This came about as a result of the feelings of a few individuals who wanted to gain control of the whole organization. The president should have recognized, understood, and even contributed to the formation of these groups.
The setting of St. Bruno’s hospital was considered formal. The institution experienced reversed method of power flow whereby the authority was exerted from bottom to top instead of from top to bottom. In this case, the organization chart consisted of the Board of Directors, Sister Petrus, Medical Director auxiliary, and Physicians; where those with the most authority possessed the least power and those with the least authority possessed the most power.
The electoral process was adopted in order to control the small group of ruling physicians. The election of medical staff was based on political affiliations within the Institution. More importantly, physicians who were not affiliated with this ruling class found it very difficult to contribute to the reformation of the formal system within the institution. For instance, several board-certified specialists left the staff in dissatisfaction with referral patterns and held the general practitioners responsible for their low numbers of patient referrals. As a result, new specialists were discouraged in affiliating with the hospital and the size of the staff remained controlled – to the benefit of the core group.
Background and Contextualizing the Problem
There were complaints about how Sister Petrus handled her duties within the institution. The problem was that the hospital board was deprived of its responsibilities by Sister Petrus, who did not inform them appropriately on the hospital’s practices and areas where actions were required. This caused a deep misunderstanding between the board members and the president of the hospital’s staff. The perpetual lack of cooperation from the staff made it difficult for the formulation of policies hence the unsuccessful resolution of patient-oriented issues (McClelland, 1985).
The hospital was under the authority of the Vatican council, which saw the readjustment of the institutions governing principles to conform to religious orders. There was the plan of decentralizing power from corporate governance down to the creation of a local board of trustees in each hospital. Decentralization of power created some support in policymaking and implementation. The hospital under the Darling decision could now monitor the roles of individual employees in each department besides their direct duties to patients. Before the adoption of Darling’s decision, it was too difficult to establish the hospital’s liability since the medical staff and its committees seemed disorganized.
Alternative courses of action
Due to some disorganization within the medical staff, it was agreed upon that instead of using formal audit reports to keep the staff accountable for their duties, the process of reorganizing the staff could, more importantly, help in establishing clear rules on accountability. The changes could help create lasting solutions to the problems facing the medical staff and patient care issues. The reorganization was to be centred around some medical staff by-laws which were to include some directive points which are; Any report from the medical staff must follow the chain of command whereby all medical staff must not report directly to the board but first pass through the hospital’s president, the annual elections of departmental heads to be done away with, the work of the board would be to appoint the departmental heads upon the agreement with the medical staff and all chairmen will be considered under the hospital’s payroll, chief of staff whose functions will be different from that of the president would be appointed by the board and then the privileges to be granted to staff will be decided upon by the medical executive committee (Hirschhorn & Young, 1991).
Bylaws committee was appointed to revise the laws and they decided to go to some neutral ground. The committee through their president and president-elect of the staff approved the revision by accepting the points incorporated by Beal. They also discussed and agreed upon other terms concerning departments and selection processes. Reorganization is what led to the establishment of a Bylaws Drafting committee. Comprised of seven physicians, this group of individuals served as her initial means of gaining majority alliance. As she experienced difficulties in drawing support from the majority, her close interactions with the committee would forge a social relationship with members of the opposing group. Knowing that scheduling a group trip to a Colorado national conference would establish solidarity, she had to decide whether two members who were unable to attend should be excused, replaced or their two slots eliminated. If excused, they would not be able to relate to the shared experience and may disagree with the decisions made. The same would occur if their replacements were in place after the conference. However, if the number of the committee members dwindled from seven to five, the time cost in finding replacements and the account of lost training time would accentuate the benefits of a smaller committee.
With regards to the proposed bylaws, Sister Petrus had to make a decision on the voting privileges of the entire staff. Her options were to either mandate staff involvement or to exclude staff voting. With an understanding of the physician staff, the political dynamics were taken into immediate consideration. Moreover, the time in which the core group quickly terminated staff plans of electing a president-for-change, served as a prime example for staff to be excluded from the voting process. Further, if the decision of several physicians was easily swayed and/or terminated by the powerful few, then it was highly likely that reform would not take place if a staff was given voting privileges.
Options and Plan of Action
The president Sister Petrus should have had the ability to follow procedures and balance her administrative work to avoid causing unnecessary mayhem amongst other medical staff. The president should avoid protecting herself before assessing the magnitude of damage that unconscious concern could cause. They should avoid using shortcuts in creating solutions to the already existing problems. The hospital has to develop a quality assurance program which will be made by medical staff to ensure that their contributions are recognized within St. Bruno’s hospital.
With an overall knowledge of the physician dynamics, Sister Petrus used the “divide and conquer” as well as “cooptation” tactics to win a play of power. Although the core group appeared united, she figured this to only be a façade. As exemplified with the signage of membership forms, the majority of physicians completed and submitted the forms by the first deadline; illustrating compliance with the new policies. On top of that, she went ahead to select a few and former members of the opposing group as members of the Bylaws committee and this led to positive results. The social relationship and solidarity that ensued showed that some, not all, had to be won over in a play of power. It should be made clear that it is the responsibility of the whole medical staff to ensure that excellence in patient care is maintained throughout.
The theme of division characterized the initial operations and activities within the hospital. This was basically made easy by the split that existed among the board members. The splits reinforced the informal groups since each wanted a place where he/she could fit in and have a sense of belonging, creating an easier scapegoat to ignore medical responsibilities and patient-related issues (Hirschhorn, 1988). The board members internalized the image of their president Sister Petrus on how she handled some decision-oriented practices. Such issues arise because the staff felt very inferior towards their unprofessional work towards patients. The splitting was experienced through the groupings within the board members and the medical staff. The manager should have maintained solidarity through the motivation of employees by giving them rewards for every positive contribution and also be ready to listen to them (Buckingham, 2005).
Buckingham, M. (2005). What great managers do. Harvard Business Review, 3, 70-79.
Hirschhorn, L. (1988). The workplace within: Psychodynamics of organizational life. Cambridge, Mass, MIT press.
Hirschhorn, L. & Young, D. (1991). Dealing with Anxiety of working: Social defences As coping strategy. San Francisco, Oxford.
Locke, E.A. & Latham, G.P. (1990). A theory of goal setting and task performance. Englewood Cliffs, NJ: Prentice-Hall.
McClelland, D. C. (1985). Human motivation. Glenview, IL: Scott, Foresman.