Methods Improvement


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C a s e 1

More Help Needed—Now!

Primary Topic—Decision Making

Additional Topics—Criticism and Discipline; Employee Problems and Problem Employees; Methods Improvement

You are manager of the health information management department of Memorial Hos- pital. You have 20 people in your group. Three of your employees have the title super- visor, but all are usually more involved in doing the work of the department than in supervising others. One of these, your transcription supervisor, is expected to devote 60 percent of her time to transcription duties and the other 40 percent to supervision.

Several times in recent months the transcription supervisor has mentioned that the backlog of work was growing and that she needed more help. She has never been more specific than simply saying that “more help” was needed, and her complaints seemed to be no more than passing remarks offered without preparation or forethought. Since you have been under pressure from a number of directions and your transcription supervisor’s complaints seemed to represent no more than chronic grumbling, you have not felt compelled to add the transcription backlog to your currently active worries.

However, today, Monday, the transcription supervisor sought you out and con- fronted you with: “I need one more full-time transcriptionist and I need her now. I’m tired of waiting and tired of being ignored, and I’m sick of being overworked and taken for granted. If something isn’t done about it by Friday, you can find yourself a new transcription supervisor.”


Propose at least three possible solutions to this problem and describe the potential advantages and disadvantages of each.

The case places you in a trap. Describe this trap, explain why it is a trap, and explain how you believe you should proceed toward a solution in view of the hazards you face.

Explain what you believe is the general condition that caused the specific prob- lem described in the case. Who is responsible for the matter, and what can be done to address the cause?

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C a s e 2

Up froM tHe raNks

Primary Topic—Leadership

Additional Topics—Authority; General Management Practice; Time Management and Personal Effectiveness

After 8 years as a staff nurse in a medical/surgical unit, Julie was appointed head nurse of that unit. After a meeting at which her promotion was announced, Julie found herself surrounded by three coworkers offering their congratulations and other comments.

“I’m really happy for you,” said Sarah, “but I suppose this means our car pool is affected. Your hours are bound to be less predictable now.”

Elaine said, “And the lunch bunch, too. Management commitments, you know.” The emphasis on management was undeniable. Julie was not at all sure she was happy with what she was hearing.

Jane offered, “Well, maybe now we can get some action on a few age-old prob- lems. Remember, Julie, you used to gripe as much as we did.”

“We’ve all griped a lot,” Sarah agreed. “That’s been a way of life around here.” Her tone changed and her customary smile faded as she added, “Now Julie’s going to be in a position where she can do something, so let’s hope she doesn’t forget who her friends are.”

Elaine and Jane looked quickly from Sarah to Julie. For an awkward 10 seconds or so, nobody spoke. At last, someone passing by spoke to Julie, and as Julie turned to respond, Elaine, Jane, and Sarah silently went their separate ways.


1. What possible advantages does Julie have in becoming supervisor of the group of which she has long been a member?

2. What are the possible disadvantages that may present themselves to Julie? 3. If you were Julie, how do you believe your promotion would affect your

relationships with your former coworkers?

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C a s e 3

tHe sileNt GroUp

Primary Topic—Meeting Leadership

Additional Topics—Change Management; Communication; Motivation

As the admitting manager recently hired from outside, it took you very little time to discover that morale in the department had been poor for some time. As you worked to become acquainted with your employees by meeting with each of them alone, you soon became inundated with complaints and other evidences of discontent. Most of the complaints involved problems with administration and the business office and the loose admitting practices of physicians, but there were also complaints from the admitting staff about other members of the department and a couple of thinly veiled charges concerning admitting personnel who “carry tales to administration.”

In listening to the problems, you detected a number of common themes. You decided that much misunderstanding could be cleared up if the gripes were aired openly with the entire group. You then planned a staff meeting and asked all employ- ees to be prepared to air their complaints—except those involving specific staff members—at the meeting. Most of your employees seemed to think such a meeting was a good idea, and several assured you they would be ready to speak up. However, your first staff meeting was brief. When offered the opportunity to air their gripes, nobody spoke.

The results were the same at your next staff meeting 4 weeks later, although in the intervening period you were again bombarded with complaints from individuals. This experience left you frustrated because many of the complaints you heard were problems of the group rather than problems of individuals.


1. What can you do to get this group of employees to open up about what is bothering them?

2. How might you approach the specific problem of one or more of your employees carrying complaints beyond the department; that is, “carrying tales to administration?”

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C a s e 4

tHe repeat offeNder

Primary Topic—Criticism and Discipline

Additional Topics—Communication; Delegation; Employee Problems and Problem Employees

“So I slipped up and made a mistake,” said chemistry technician Arnold Adams. “All that proves is that I’m human, that maybe I’m a little careless once in a while, like everybody else.”

“I can’t call your behavior carelessness,” said laboratory manager Elsie Clark. She slid a piece of paper across her desk to Arnold and continued, “I have to call it negligence, and that’s what this warning notice says.”

Arnold scowled and said, “I don’t deserve a warning and certainly not for negli- gence.” He spread his hands and added, “What am I supposed to be—perfect? I can’t make an honest mistake once in a while?”

“You can’t make mistakes like this one. The test request was clearly marked stat but you logged it in as routine and it sat for several hours.”

Arnold shrugged and said, “Nothing happened to the patient, did it?” “No,” Elsie answered, “but Dr. Baker ordered it stat because of this particular

patient’s history. Something could have happened—we’re just lucky it didn’t.” “So nothing happened,” Arnold repeated, “but I get a warning in my file? If a

warning’s supposed to be a form of punishment, how come I’m punished for some- thing that didn’t cause any harm?”

Elsie said, “Arnold, you’re all by yourself every night at the satellite. We must be able to depend on you to process all requests according to procedure and to perform all stat work as it’s received.”

Arnold simply scowled at the warning notice as Elsie added, “And this sort of thing has got to stop. This is the fourth conversation we’ve had like this, and the most serious yet.”

“Fourth?” Arnold’s eyebrows rose. Elsie nodded. “In 3 years,” she said. “I can’t believe you’d hold some thing against me that happened 3 years ago. A

warning that old ought to be wiped out. You’ve got no business using that against me.” “I’m using it only to point out a pattern. You seem to go along fine for 8 or 9

months or so, then up comes a major problem again.”

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“Just bears out what I said before,” Arnold said. “I’m human. I make mistakes. And 8 or 9 months since the last mistake entitles me to a clean slate.”

“I can’t agree,” Elsie said. She handed Arnold a pen and added, “Please sign the form to show that we’ve discussed this. You can write out any objections or com- ments in the space at the bottom. And should we have such a conversation again, you may find that more than a written warning is involved.”


1. Consider Elsie’s statement, “You can’t make mistakes like this one.” Is this a valid statement? If yes, why?

2. What is wrong with Arnold’s description of a warning as “a form of punishment?”

3. How would you deal with the repeat offender if you were in Elsie’s position?

Case 4: The Repeat Offender 37

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C a s e 5

a Good eMployee?

Primary Topic—Criticism and Discipline

Additional Topics—Communication; Employee Problems and Problem Employees; Rules and Policies

Housekeeping supervisor Ellie Richards was faced with a situation that left her feel- ing uncomfortable about the action she would have to consider taking. In discussing the matter with Stan Miller, the other housekeeping supervisor, she began: “I have no idea how I should deal with Judy Lawrence. I just don’t recall ever facing one like this before. Her attendance has deteriorated and this once truly good employee is causing problems for the department as a whole.”

Stan asked, “What’s the problem?” “Excessive absenteeism,” Ellie answered. “Judy has rapidly used up all of her

sick time, and most of her sick days have been before or after scheduled days off.” “What’s unusual about that? Unfortunately, we have several people who use

their sick time as fast as it’s accrued. And most get ‘sick’ on very convenient days. I have a couple I can count on to do it regularly.”

“What’s unusual is the fact that it’s Judy Lawrence. She’s been here 7 years, but this apparent sick time abuse has all been within the past few months. She’s used up her whole sick-time bank in 7 months. And most recently, she was out for 3 days without even calling in.”

Stan said, “You can terminate her for that.” “I know,” said Ellie. “Especially when you take her other absences into account. You’ve warned her

about them?” After a moment’s silence Ellie said, “No, not in writing. Just once, face to face.

I really didn’t want to put pressure on her.” “Any record of it? Fill out a disciplinary dialogue form for her to sign? Some-

thing you’ve filed—even in your own office?” “No,” said Ellie. “I really hated to. I know I should have taken some kind of

action by now, but I can’t seem to make myself do it.” Stan asked, “Why not?” “Because she’s always been such a good employee. She’s always been pleasant,

she’s always done what she’s been told to do, and she’s always done quality work.

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She’s still that way, except for her attendance problems of the past 7 months. I’m really afraid there’s something wrong that she’s not telling anyone.”

Ellie shrugged and continued, “I guess what I’m really hung up on is: How do I discipline someone who is usually a good employee, and do it in such a way that it doesn’t destroy any of what is good about her?”

Stan shook his head and said, “Good performer or not, I’d say you ought to be going by the policy book. That’s all I can suggest.”


1. How would you advise Ellie to proceed in the matter of Judy Lawrence? 2. Do you feel that Ellie’s failure to take action thus far affects her ability to take

action now? Why or why not?

Case 5: A Good Employee? 39

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C a s e 6

tHe CliNGiNG ViNe

Primary Topic—Delegation

Additional Topics—Communication; Criticism and Discipline; Employee Problems and Problem Employees; Leadership; Motivation

“I feel like I have an open line of communication with Brenda,” said building services supervisor, May Carey, “and maybe that’s part of the problem. She never hesitates to come to me about even the smallest matter that she ought to know she can take care of without me. She checks in with me so often that I feel I might as well be doing her work in addition to my own.”

Jane Scott, a head nurse and May’s carpool companion, said, “Maybe you ought to be glad that she keeps you informed. I wish some of my nurses were better about bringing things to my attention. I don’t know if there’s such a thing as too much communication.”

“In this case there is too much,” said May. “Half of what Brenda brings to me is simple stuff, regular parts of her job that she’s expected to take care of. And she’s always asking me what to do next—and if she can’t find me right away, she doesn’t do anything until I show up and give her new instructions.”

Jane asked, “How did Brenda get along with your predecessor? Same problem?” “I don’t know. The last supervisor’s style was a lot different from mine. She

seemed very authoritarian in the way she ran the department.” “Do you suppose Brenda ever got in trouble for not checking in? That may be

why she thinks she’s expected to do what she’s doing.” “I don’t know that either,” May answered. “There’s been so much to do that I

haven’t really begun to uncover all of the major problems in the department. I’ve been stalled for 6 months just trying to get at our antiquated job descriptions.”

“Well,” said Jane, “I should think you’d be glad to have the open communication that you have with Brenda.”

“I am,” said May, “and I’d like to keep it. But how can I go about getting her to work more independently without damaging that open line of communication?”


Develop a recommended approach for May to follow in instilling more independence in Brenda while attempting to maintain open communication with her.

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C a s e 7

tHe iNHerited probleM

Primary Topic—Employee Problems and Problem Employees

Additional Topics—Communication; Criticism and Discipline; Delegation; Leadership

Shortly after she moved into the position of kitchen supervisor, Donna Wayne decided that a food service aide named Sandra Cleary was emerging as a problem employee. Sandra, nearing the end of her 6-month probationary period, was frequently idle. She would apparently do what she was told to do and then do nothing until specifically assigned to another task. Donna grew especially sensitive to the situation when she began to pick up grumblings from several other workers about Sandra not doing her fair share of the work.

Because she did not want to be unduly influenced by what others might have said, Donna did not look at Sandra’s record when she drafted Sandra’s 6-month review. She tried to avoid focusing on the employee’s attitude, which at best seemed to be distant and disinterested, and instead attempted to focus strictly on Sandra’s performance. Even this approach yielded a highly uncomplimentary review; Donna had already decided that Sandra was probably the department’s worst performer.

Donna set up an appointment for Sandra. In opening her conversation with Sandra, Donna said, “I’ve deliberately avoided looking at your 3-month review, but I’ll be surprised if it’s much better than the one I have to give you now.”

Sandra responded with, “What 3-month review? I didn’t know I was supposed to have one.”

Astonished at this response, Donna dropped her plans to discuss the 6-month evaluation. Instead, she turned the conversation to Sandra’s experience over the pre- ceding 6 months. In her discussion with Sandra, and through personal investigation and a review of Sandra’s record, Donna learned that:

• Sandra indeed had never been given a 3-month review, and in all probability had never been told there was such a review.

• Sandra had never been told that she was performing unsatisfactorily. • Sandra felt that she was expected to wait for instructions before beginning any

new task. • There were no warnings or other indications of trouble in Sandra’s personnel


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It was with dismay that Donna reviewed the problem: The employee’s perfor- mance was below standard, apparently through no fault of her own, and yet the pro- bation period had expired and the employee was expected to be fully functioning.


1. What probably caused the problem with Sandra to develop? 2. What should Donna do to try to correct the problem? 3. What should Donna tell Sandra about the apparent happenings of the past

6 months?

42 Case 7: The Inherited Problem

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C a s e 8

tHe well-eNtreNCHed eMployee

Primary Topic—Change Management

Additional Topics—Delegation; Employee Problems and Problem Employees; Leadership; Motivation

When Dave Farren was hired from outside to be manager of communications for University Hospital, he gave little initial thought to the one-person mail room opera- tion that was part of his department. However, he was soon forced to focus on the mail room because of an alarming number of complaints he received about mail room service. Other departments and elements of his own department complained of slow service on outgoing mail, late and erratic service on incoming mail, and frequent losses of interdepartmental mail.

The mail room operator, Mary West, was a long-time employee who had been in the same job more than 20 years. Her title was actually mail room supervisor, although she had never directly supervised any other employees. However, she had always been left to function very much on her own.

Before Dave could begin to make sense of the complaints about the mail room, Mary West launched something of a complaint campaign of her own. She insisted that she needed a full-time helper in the mail room, claiming that “There’s far too much work here for one person and there’s nobody to help me.” However, Dave quickly learned from others that Mary’s “I need help” campaign was an approach that she had used on all of his predecessors over the years.

Dave’s first visit to the cramped, out-of-the-way mail room left him appalled. The area was cluttered, with battered interoffice mailers piled everywhere and just plain junk accumulated in every available space. Although Dave was ready to con- cede that some physical improvements could aid the situation, he was also forced to conclude that the biggest problem area was Mary West’s complete lack of an efficient approach to the job.

Dave offered some suggestions aimed at improving the operation of the mail room. However, for the most part his suggestions were met with icy silence and he later picked up secondhand complaints to the effect that Mary wanted “real help, not some new boss nosing

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