Case Studies For Doctoral Learners

According to General Colin Powell, “Great leaders are almost always great simplifiers who can cut through argument, debate, and doubt to offer a solution everybody can understand” (as cited by Harari, 2002).

Assignment Preparation

For this assignment, imagine that you are the manager of a health care organization confronting numerous issues potentially affecting the provision of safe, high-quality health care practices. You have decided to focus first on the issue that has particular relevance to your area of specialization or professional goals, or that presents a situation you might expect to encounter in your leadership role. As you consider an appropriate course of action to address this issue, you have decided to begin by searching the case study literature with the intention of possibly gaining insight into the actions of other health care leaders who have dealt with similar issues and may have provided a sound solution to the problem or issues he or she faced.

A colleague with whom you have spoken about this has recommended the Buchbinder, Shanks, and Buchbinder text, Cases in Health Care Management as an excellent case study reference.

For your convenience, Appendix B lists all cases by topic (Leadership; Quality/Patient Safety; Finance; Healthcare Professionals/Human Resources; Health Disparities/Cultural Competence; Ethics/Law/Conflict of Interest; Crossing the Line/Fraud) and by primary and secondary settings.

In the Buchbinder, Shanks, and Buchbinder text, locate two case studies that are most closely aligned with the issue(s) you have decided to address. In addition, be sure that your selected case studies will enable you to

· Evaluate the effectiveness of different leadership approaches in facilitating collaborative professional relationships across disciplines.

· Evaluate health care leaders’ ability to communicate effectively.

· Analyze the role of communication in both creating and resolving a problem in health care leadership.

· Evaluate how effectively leaders address any issues involving ethical practice, diversity or inclusion.

· Evaluate health care leaders’ ability to manage and prioritize leadership responsibilities to resolve issues.

Note: The case studies in the text may not supply all of the information you may need. In such cases, you should consider a variety of possibilities and infer plausible conclusions.

Assignment Instructions

Complete the following steps:

1. Include a title page, abstract, and reference page.

o An APA Style Paper Tutorial [DOCX] and the associated APA Style Paper Template [DOCX] are linked in Resources to help you in writing and formatting your paper. Format your work per these documents.

2. Include on your cover page the titles of the case studies you have chosen. For example, your title could read: “Demonstrating Effective Leadership: Case 82 – When Yes Means No and Case 83 – Emergency Divert Status.”

o Include the case study in your references and use in-text citations when appropriate.

3. In the body of the paper, begin by briefly summarizing the facts surrounding the case studies. After you identify who the leaders are and the issues they are faced with, analyze the factors that you believe contributed to each issue.

o Note: In graduate level writing, you should minimize the use of direct quotes. Lengthy quotes do not count toward assignment minimums. It is your interpretation of the material and its application to practice that is assessed.

o Remember, the case studies may not supply all of the information you may need. In such cases, you should consider a variety of possibilities and infer plausible conclusions. However, please be sure to identify any speculations that you make as such.

o An excellent tool for analyzing factors that contribute to a problem is the Fishbone Diagram, linked in the Resources. Use of this tool is highly recommended, but it is optional, and you will not hand in your diagram with this assignment.

4. Compare and contrast the leadership approaches or styles these leaders use. Analyze how the approaches or styles make these leaders more or less effective in building interprofessional relationships across disciplines within the organization. Based on your analysis, determine how likely it will be that these leaders will be able to build and maintain such relationships with other communities and leaders outside their organization. Support your analysis with citations and appropriate APA references to peer-reviewed journals or scholarly sources.

5. Analyze how well these leaders communicate, verbally or in writing. Analyze the role of communication and communication strategies in both creating and resolving the issues presented in the case study.

6. Summarize and analyze how well the leaders managed professional responsibilities and priorities to resolve the issue in the case. What lessons could you take away from this case that could be applied by other leaders?

7. Summarize and evaluate how effectively the leaders addressed any issues involving ethical practice, diversity or inclusion in the case. What key lessons do these cases provide for leaders? Use examples to clarify and support your ideas.

Submission Requirements

Your paper should meet the following requirements:

· Written communication: Write coherently to support central ideas, in appropriate format, and with correct grammar, usage, and mechanics.

· Length of paper: 5–6 typed, double-spaced pages, not including the title page, abstract, and reference page.

· References: At least four different resources (peer-reviewed journals or other scholarly resource, assigned unit readings, and the like).

· APA formatting:

o Include a properly formatted title page, abstract, and reference page.

o An APA Style Paper Tutorial [DOCX] and the associated APA Style Paper Template [DOCX] are linked in Resources to help you in writing and formatting your paper. Format your work per these documents.

o Apply correct formatting to all in-text citations and references.

· Font and font size: Times New Roman, 12 point.
Mini-Cases for Diversity
Sharon B. Buchbinder and Dale Buchbinder

Case 61

1. At a rural hospital’s free mammogram clinic, a Hispanic woman who lives a long distance away from the hospital is found to have an advanced case of breast cancer. Rather than have the woman travel back home and delay treatment, the woman is admitted to the hospital on the spot. A bilingual janitor is called upon to serve as the interpreter to explain what needs to be done. The woman signs the informed consent form. However, the next day when she learns her breast has been removed she becomes very angry.

2. A 36-year-old pregnant Orthodox Jewish woman who has ten children visits her female gynecologist, a Reform Jew, because she has large and painful vulvar varicose veins. The woman’s husband remains in the room during the examination and answers the physician’s questions for the woman. At length, the woman asks what she can do to prevent this problem in the future. The physician responds that the reason she has the varicose veins is that the hormones of pregnancy cause increased blood to the region. The problem will go away when the patient is no longer pregnant. The husband becomes enraged and tells the physician she has no right telling them how many children to have.

3. A patient hears shouting coming from the room of an Iranian patient across the hall from her. She buzzes the nurse, who runs into the room and finds the elderly patient in the midst of a shouting match with his son. She asks the family if they could please calm down, their argument is disturbing other patients. The two men look at her in complete astonishment and the son says, “Argument? What argument? We were having a discussion.”

4. An African American child is admitted to pediatrics in an inner-city hospital and the family informs the nursing staff that their four-year-old daughter is deaf and they use sign language to converse with her. Later that evening when a certified American Sign Language (ASL) interpreter comes to the room to assist the nurse in explaining some procedures, the child does not understand the interpreter and waves her fingers around in a pattern that is completely unlike ASL. The nurse and the interpreter are baffled. The nurse accidentally drops a tray on the floor as she leaves to find her manager—and the child turns her head to the sound.

5. A new Latina graduate of an MHSA program is hired to be in charge of a quality improvement and patient safety initiative at a hospital in Washington, DC. On her first morning at work, she asks her administrative assistant, an older African American woman, to schedule one-on-one appointments for her with key employees involved in the new program. She wants to see them starting on the next day, so she asks her assistant to start making the appointments as soon as possible. The administrative assistant nods, says nothing and returns to her computer work. At the end of the day, the administrative assistant has made no appointments for her new boss.

A Community-Based Health Care Clinic Takes On the Complicated Issue of Abuse
Donna L. Wagner and Kelly Niles-Yokum

Case 72

La Familia, a community-based health care clinic serving a low-income rural, primarily Hispanic population, has been a trusted source of primary health care for nearly 30 years. When Jane Rodriquez took over as Executive Director six months ago, she knew she was going to be facing many challenges related to the pervasive poverty in the region and among those served by the clinic. In her training to become a professional health care manager, she studied the associations between low income and chronic illnesses such as diabetes, high blood pressure, and obesity, and problems such as alcohol and substance abuse. But as the wife of a Hispanic man with a large, close-knit family, she also had seen how resilient and supportive families were and how valued the family was in the Hispanic culture. Family was everything and often the only thing that could be relied upon when times got tough.

During her first few weeks on the job, Jane made it a point to stop by the waiting room to speak with the patients. Their practice included patients from infancy to centenarians, cared for by a very busy staff of dedicated physicians, nurses, and aides. On one of her visits to the waiting room she met Bea, an 80-something-year-old great-grandmother who was being seen for high blood pressure. Bea lived in an extended family with her son and daughter-in-law, their adult daughter, and her three young children. A widow, Bea enjoyed looking after the great-grandchildren and taking care of the household. Jane noticed several large bruises on one of Bea’s arms and a healing laceration on her cheek and asked about it.

“Looks like you took a pretty serious fall, Bea,”Jane remarked.”

Si.”replied Bea. “My balance not too good.”

After a few more pleasantries, Jane returned to her office.

Later that evening, Jane told her husband about her interaction with Bea and wondered out loud exactly how many of their patients might be falling and not mentioning it to their health provider. She had read about the epidemic of falls among older persons and wondered if there was something the clinic might do to reduce the fall risk for their patients. The next morning at the staff meeting she brought up the topic of falls with the clinicians. Several nurses and the three physicians all agreed that they had noticed some injuries with their older patients and they discussed how they might explore this health risk in the future. Since many older patients are reticent about talking about things that might give others the impression they were losing capacity, falls being one of these topics, the staff thought they would do a little stealth surveillance about falls.

“Let’s ask the kids whether their abuela falls down occasionally,”suggested one of the nurses.

“Great idea,”replied Jane, “If we find out this is a problem for several of our families, we should try to get a fall prevention program started.”

At the next staff meeting, Jane asked about the surveillance project. The responses were surprising and upsetting. One 10 year old told the nurse who was checking her weight that her grandmother fell down only when her mother pushed her because she was mad. A 15 year old replied that “…we’re not supposed to talk about that,”and a 12-year-old girl started to cry when asked about her grandmother falling down. It was clear that something else was going on and the staff began to weigh in on the possible meaning of these responses.

“If these elders weren’t living with their families, I would suspect elder abuse,”offered one nurse.

Jane decided to conduct a little research about elder abuse herself and what she found was surprising. According to the National Center on Elder Abuse, studies suggest physical abuse is the most common form of elder abuse with women, and the very old are most likely to be victims of abuse. Elder abuse cuts across all socioeconomic lines and ethnic groups. It is estimated that only a small percentage of the actual abuse, involving between one million and two million elders, is actually reported. And, most perpetrators in the community are family members: spouse, adult child, or grandchild.

Jane also discovered that all health professionals have a duty to report any suspected elder abuse to the Adult Protective Services. Jane learned that elder abuse can carry with it lifelong health and mental health problems for the elders. Her investigation turned up a model of intervention that she thought could be modified to fit in their practice. This model teams up Adult Protective Services professionals with medical experts to assess the elder and develop a set of recommendations that would help both the elder and the family member(s).

On her list of things to do she included: (1) contact the Adult Protective Services to come in and do an in-service for everyone working for the clinic about elder abuse and its consequences and the legal responsibilities of health providers; (2) identify two or three staff members to take the leadership in designing a team intervention; (3) assign to the promotora, the community health worker, the task of developing educational material for the families they serve and the neighborhood in general;and, (4) schedule a staff meeting to discuss and develop a procedure for early identification and outreach to the elder and her or his family members. With the list complete, Jane felt that she had things well in hand and a plan that might work. One unknown was whether the trust she thought was present between her staff and the patients was strong enough to survive the difficult conversations that were going to have to take place in the very near future.

Adult Protective Services in your state

Buchbinder, S. B., &Shanks, N. H. (Eds.). (2012). Introduction to health care management (2nd ed.). Burlington, MA: Jones &Bartlett.

Fisher, B., &Regan, S. (2006). The extent and frequency of abuse in the lives of older women and their relationship with health outcomes. The Gerontologist, 46(2), 200–209.

Long term care ombudsman (for abuse in nursing homes or assisted living facilities)

Morrison, E. E. (2011). Ethics in health administration: A practical approach for decision makers (2nd ed.). Sudbury, MA: Jones and Bartlett.

Mosqueda, L., Burnight, K., Liao, S., &Kemp, B. (2004). Advancing the field of elder mistreatment: A new model for integration of social and medical services. The Gerontologist, 44(5), 703–708.

National Center on Elder Abuse.

Niles-Yokum, K., &Wagner, D. (2011). The aging networks: A guide to programs and services (7th ed.). New York, NY: Springer.

Office of Minority Health. (2001). National standards for culturally and linguistically appropriate services in health care: Final report. Washington, DC: U.S. Department of Health and Human Services.