You are a new DNP working in an outpatient multi-specialty corporate owned setting, the same center your scholarly project was completed in: Medical Center of the West (MCW). Providers are employed by the healthcare system. During your coursework and scholarly project completion, you observed some concerning scenarios among colleagues in the workplace that collectively require strong leadership intervention.
36 yr old male APRN in neurology: newly dx with pre-DM, has gained 20# over past 3 yrs since taking job at MCW. Attributes this to long days, eating on the run, and no longer time for exercise. States he hardly ever gets to see his wife and children due to demands of work, including several hours every night charting in the EMR. He states he feels shorter tempered with administration lately as new initiatives are rolled out. He states, “we are merely employees…they don’t seem to care about our expertise anymore, just tell us what to do”.
48 yr old endocrinologist: Previously owned and operated own practice with physician spouse, spouse fell ill necessitating closure of practice. In addition to the MD degree, holds a master’s in social work giving her a highly relational, high touch/high care approach to patient care. Hired as medical director of new Endo department. During the 15 month tenure became increasingly frustrated at unanswered requests for support staff, inability to get standard of care devices such as professional continuous glucose monitors, and modern computers for insulin pump downloads. Staying until 7pm most nights, sometimes until 9pm. No longer able to play organized sports after work, and states hardly ever saw her 12 yr old son. After several frank and open discussions with administration without a mutually agreeable plan to address the issues, endo leaves the practice.
60 yr old Family Practice Physician/PCP: In practice x 25 years. Quality of care, personal outlook on the medical system and self-care began slipping the past 2 years. At the same time, elderly father’s health was slowly failing. While previously the PCP would handle complex patients, he started referring common primary care health problems to specialists in effort to manage schedule and make it through the day. Despite this, would have to take work home every night. Decided to retire, notified administration, and was not allowed to work out notice due to “attitude.”
32 yr old Physician Assistant/PCP: Worked 3 years for MCW straight out of school. Satisfied and challenged the first 2 years. Year 3 told had to see 4 more patients per day: 2 new, 2 established, resulting in longer days, less evening time with family. The new patients were mostly medically complex and part of the state’s ACA Medicaid expansion, or patients seeking pain management. Increasing regulations around pain medication prescribing due to the nationwide opiod crisis were forcing many providers in the state to stop pain management services. The PA was verbally assaulted several times in year 3, and twice physically punched by patients who were denied opiods. The 2nd physical assault in addition to the longer hours were cited as reasons to change employers to a private dermatology practice.
50 yr old Physical Therapist: “I left the healthcare field. I was expected to see the same number of patients with increasing paperwork and documentation time. I was spending double the time documenting as I was giving care”.
As you write your 12-15-page paper focusing on leadership and change theory, please consider the scenarios as a group. You do not need to analyze each one individually, but rather look for common cues or themes. Utilize the IHI.org Deming’s System of Profound Knowledge (System, Theories, Variations and Human Behavior) as the framework in consideration of needed change for improvement.
- What is likely going on here (and how do you know)?
- What are the clinicians experiencing?
- What (2) leadership theories would help guide you in addressing this problem? Specifically apply them.
- From a healthcare system perspective what are potential contributing factors? While you may not know everything about the system, research some known healthcare system issues. As discussed in the IHI video, consider variations and human behaviors (including but in no way limited to VABEs).
- Choose a change theory and formulate a change plan to address and improve the problem.
