CASE STUDY: The Teaching Hospital

Point of View
The point of view is in third-person that points out to understand the complexities and
challenges of managing a teaching hospital in which there are different units with conflicting
interests and how to resolve the problems arising from such differences while maintaining high-
quality patient care.

Synopsis/Summary
The Teaching Hospital is a state-supported medical center with over 1000 beds that
houses a medical school and hospital. However, there is a constant undercurrent of hostility and
competition between the two institutions, which has resulted from their separate financial
arrangements. While the physicians receive salaries, patients are billed for professional services,
and the revenues go into departmental funds. The hospital, on the other hand, turns over every
patient-revenue dollar to the state and has to account for every penny of operating revenue it
gets.
In this context, Dr. Robert Uric heads the Renal Medicine Unit at the teaching hospital.
Despite difficulties, he is well-liked by the hospital employees with whom he works, as he shares
his grant monies with the hospital employees in his unit. Dr. Uric has several federal grants from
the National Institutes of Health (NIH) to pursue research on kidney transplantation. In the
course of his work, he discovers a fluid that could extend the life of cut flowers, which he offers
to a large nursery-supply manufacturer. The firm buys it, names it Flower Life, and begins
making millions. After NIH officials filed a suit, the story broke in the newspapers, bringing
attention to Dr. Uric’s peculiarities. At the next executive committee meeting, the heads of the
clinical departments suggest that Dr. Uric should be put in a “less visible” position until things
quiet down. Consequently, Dr. Uric is offered a new research chair in medicine, which he
accepts.
Dr. George Conrad, the chief resident of renal medicine, is placed in charge of the
dialysis unit. Despite being bright and extraordinarily dedicated, his reference letters reveal him
to be inflexible and rather ruthless. However, Conrad’s “strong hand” approach leads to
increased absences and constant grievances within the unit. After three months, ninety of the old
employees were gone.The roster of residents applying to the service drops dramatically, and
Uric’s research work becomes stale. He fails to turn in a grant progress report on time, and the
granting agency cancels the remainder of his funding.
Eventually, a patient who had been on dialysis for several years decides to give up her
place and go home to die after waiting a long time for a transplant. The news reveals the
situation to be much worse than any tales of Dr. Uric’s weird habits could possibly have been.
Shocked by the realization of how bad the situation had become, the executive committee
immediately places Uric back as the head of the renal unit to analyze what had happened and
what could be done to put the real unit and the hospital’s reputation back together.

Case Problem
The teaching hospital is facing issues of organizational structure and financial
arrangements between the medical school and hospital, leading to a hostile and competitive
environment. This is exacerbated by the integration of medical school faculty into hospital
functions, resulting in inconsistencies and tensions. The situation worsens when Dr. Uric, head
of the renal unit, creates a successful product from his NIH research grant but faces ownership
and legal issues, causing negative publicity for the hospital and prompting his removal from the
unit. His replacement, Dr. Conrad, has a different management style and leads to serious
personnel and patient care problems. The issue escalates when a patient gives up her place in the
dialysis unit due to the situation, leading to the dean and executive committee reinstating Dr.
Uric as head of the renal unit and analyzing the situation to address the underlying problems.
The main problem identified in the case study is how to manage effectively in an organization
that has competing interests and challenging financial arrangements. Additionally, leadership
change is common in academic institutions such as medical schools which may harm its
reputation if not handled properly.

Organization Behavior Theory

Organizational
Structure

Leadership Styles

Perception and
Communication Conflict Management
Attitudes
 As shown in Figure 1, the case study highlights various organizational behavior theories
and concepts, as follows:
 Organizational structure
The hospital and medical school had a split structure and physical plant that paralleled
the organizational divide, leading to a lack of cohesive management.
 Leadership styles
Dr. Uric and Dr. Conrad had vastly different leadership styles, with Dr. Uric being well-
liked and personable with both patients and staff, while Dr. Conrad was seen as rigid and distant.
This impacted the morale and effectiveness of the renal unit.
 Perception and attitudes
The hospital personnel had a negative perception of the physicians from the medical
school faculty, and vice versa, leading to a divided workplace culture.
 Communication
The lack of communication and coordination between different departments and levels
of management led to disruptions and negative outcomes, such as the patient giving up her place
in the dialysis unit.
 Conflict management
The issue of Dr. Uric’s removal from the renal unit and subsequent replacement by Dr.
Conrad led to conflict between faculty and staff, and required conflict management and
resolution by the dean and executive committee.

Discussion of Alternative

Alternative 1:
Improve communication and collaboration between the hospital and the medical school
to address the underlying conflicts and financial discrepancies.
Pros:
 This alternative addresses the root cause of the problem, which is the lack of cooperation
and communication between the two institutions.
 It can improve efficiency and accountability in the use of patient revenue and grant money.
 It can create a more harmonious and productive working environment for hospital and
medical school staff.
Cons:
 It may take a long time to implement, as it requires changing established organizational
structures and financial arrangements.
 It may require a significant cultural shift in both institutions, and resistance from some
stakeholders may hinder the process.

Alternative 2:
Reassign Dr. Uric to a role where he can continue his research but not be involved in the
day-to-day operations of the renal unit.
Pros:
 This alternative can address the reputation issue and concerns about Dr. Uric’s “undignified”
behavior while still allowing him to pursue his research.
 It can provide a fresh start for the renal unit and allow for new leadership to address the
personnel and patient care issues.
Cons:
 It may not address the underlying conflicts between the hospital and the medical school.
 It may not solve the personnel and patient care problems in the renal unit, as they may be
caused by factors beyond Dr. Uric’s leadership.

Alternative 3:
Promote Dr. George Conrad as the new head of the renal unit and provide him with
support and resources to address the personnel and patient care issues.
Pros:
 This alternative can provide strong leadership to address the problems in the renal unit.
 It can allow for a fresh start and a new direction for the unit.
 It can address the concerns that Dr. Conrad had about Uric’s involvement in the unit and
allow him to implement his own vision.
Cons:
 It may not address the underlying conflicts between the hospital and the medical school.
 It may require more resources and support than the hospital and medical school are willing
or able to provide.
 Dr. Conrad’s leadership style and priorities may not align with the needs and expectations of
the unit’s staff and patients.
Selection of Best Alternative
Alternative 1, to improve communication and collaboration between the hospital and the
medical school, is the best alternative of the three options because it addresses the root cause of
the problem, which is the lack of cooperation and communication between the two institutions.
By improving collaboration, efficiency and accountability in the use of patient revenue and grant
money can be improved, creating a more harmonious and productive working environment for
hospital and medical school staff.
On the other hand, Alternative 2 and 3 have their limitations. Alternative 2, to reassign
Dr. Uric to a different role, may not address the underlying conflicts between the hospital and the
medical school or the personnel and patient care issues in the renal unit. Alternative 3, to
promote Dr. George Conrad as the new head of the renal unit, may not address the root cause of
the problem and requires more resources and support than the hospital and medical school may
be willing or able to provide. Therefore, while Alternative 2 and Alternative 3 may provide
short-term solutions to specific problems, they are not as comprehensive as Alternative 1, which
seeks to address the underlying cause of the conflict between the hospital and the medical school.

Alternative Implementation
The implementation of this alternative is divided into 4 phases as follows:
Phase 1: Assessment
The first phase of implementing Alternative 1 is to conduct an assessment of the current
communication and collaboration processes between the hospital and the medical school. The
assessment will involve gathering feedback from hospital and medical school staff, including
doctors, nurses, and administrators, on the current state of communication and collaboration.
This information will help to identify the existing barriers to effective collaboration and
communication and form the basis for creating a strategy that addresses the issues.
Phase 2: Strategy Development
Based on the findings of the assessment, the hospital and medical school administration
will work together to develop a strategy that addresses the issues and fosters more effective
communication and collaboration. This strategy should include a clear outline of policies,
procedures, and practices for communication and collaboration between the two organizations. It
should also include specific objectives and goals for fostering collaboration and creating a more
productive working environment.
Phase 3: Implementation
The third phase of the implementation plan is to put the strategy into action. The hospital
and medical school should work together to implement the policies, procedures, and practices
that were outlined in the strategy development phase to improve communication and
collaboration. This may involve establishing regular meetings between key personnel, shared
training programs, cross-functional teams, and joint decision-making processes.
Phase 4: Monitoring and Review
The final phase of implementing Alternative 1 is monitoring and review. The hospital and
medical school should continue to assess the effectiveness of the new policies, procedures, and
practices and make adjustments where necessary. Regular feedback from staff, patients, and
stakeholders, such as grant committees, can provide valuable insight into the success of the new
communication and collaboration processes. This ongoing evaluation can ensure that the
organizations continue to work together effectively and efficiently to provide high-quality patient
care and maximize the use of grant funding.

Potential Problem
One potential problem of implementing Alternative 1 is resistance to change. Resistance
to change can manifest in a variety of ways, including reluctance to adopt new policies and
procedures, lack of engagement in collaborative efforts, and low morale among staff. This may
be particularly challenging in an environment where established routines and protocols are
deeply ingrained, and staff may be resistant to change.
Another potential problem is a lack of resources. Implementing new policies and
procedures requires time, effort and resources. The hospital and medical school may need to
allocate additional funding to train staff, upgrade existing technology systems and infrastructure,
and hire new staff to support the implementation of Alternative 1. This may create a strain on the
existing resources, which could lead to delays or a slow implementation process.
Additionally, there may be competing priorities or other initiatives that could detract
from the implementation of Alternative 1. The hospital and medical school may need to
prioritize the allocation of resources to ensure that Alternative 1 is successfully implemented
over other initiatives and competing priorities.
Finally, the success of Alternative 1 may be dependent on the cooperation of individuals
and departments outside of the hospital and medical school. This can be challenging to achieve,
as individuals and departments may have different goals and priorities that do not align with
those of the hospital and medical school. Without cooperation and buy-in from external parties,
the implementation of Alternative 1 may be less effective or have limited impact.
Fall Back Solution
If resistance to change is proving to be a significant challenge to the implementation of
Alternative 1, a potential fallback solution would be to invest more resources in change
management strategies. This could include providing more comprehensive training and support
to staff, incentivizing participation in collaborative efforts, and implementing a change
management plan that addresses common concerns and objections to the proposed changes.
To overcome the challenge of a lack of resources, the hospital and medical school could
explore alternative funding sources, such as grants or partnerships with external organizations.
Additionally, they could prioritize the allocation of existing resources to ensure that the
implementation of Alternative 1 is given the necessary attention and support.
If competing priorities or initiatives are detracting from the implementation of
Alternative 1, the hospital and medical school could re-evaluate their priorities and s to ensure
that resources are being effectively allocated to achieve desired outcomes. This may involve
delaying or phasing out other initiatives to ensure that Alternative 1 is successfully implemented.
To address the challenge of achieving cooperation from external parties, the hospital and
medical school could engage in stakeholder management strategies that aim to build
relationships and facilitate collaboration with external stakeholders. This could involve
identifying common goals and priorities, establishing shared accountability models, and
developing communication channels that allow for ongoing dialogue and collaboration.
Otherwise, the fall back solution can be to pursue Alternative 3, to promote Dr. George
Conrad as the new head of the renal unit and provide him with support and resources to address
the personnel and patient care issues. While this may not address the root cause of the problem, it
can provide immediate relief and address the most pressing issues in the renal unit. However,
this solution should only be pursued as a last resort if efforts to improve communication and
collaboration have failed.