Reference no: EM133500417

Homework: Comprehensive Approach for Conflict Resolution at the Clinic Essay

Clinic in Conflict

You have been asked by the Board of Feelgood Clinic to assess a conflict that is brewing in at the clinic. You decided to promise confidentiality to everyone you interview, although you will issue a summary of the situation to the Board of Directors. You will warn interviewees to flag any particularly sensitive information that could only come from them to make sure that you don't inadvertently put it in your summary. (PRACTICE TIP: clarity about confidentially and feedback loops are best practices for assessment.)

So far, you have had an initial meeting with the Clinic Director to get background information and interviewed Pat Parent, one of the customers at the Clinic who originally complained to the Board. The customer, Pat Parent, called a friend who is on the Board to complain about how s/he was treated at the Clinic. The clinic is concerned about Pat's situation, and other clients have increasingly complained of similar problems. The clinic hired you to do an assessment and recommend possible improvements to their internal systems to address issues and creating a dispute resolution process for patients to use.

Background Information from Pat Parent

Little Ty, age 6 months, was acting listless and running a fever. Pat Parent, got a call from Ty's daycare and had to pick the baby up. On her way to get Ty, Pat called the clinic from a cell phone to make an appointment with Doctor Wellby. "Yes," the scheduler said, "we can squeeze Ty in today at 3:15 p.m." S/he arrived on time at the clinic, checked in and waited in the lobby ... and waited ... and waited ... Finally, at 3:45, Dr. Wellby's nurse came out to get Pat and Ty, apologizing about the wait. The nurse said, "I don't know whey the schedulers told you 3:15, they are always overbooking him. I wish they could get it right!"

Pat and Ty waited in the exam room another 20 minutes. Dr. Wellby rushed in, also apologizing for keeping them waiting. "My nurse should have known better than to put you on my schedule today. The nurse should have directed you to another doctor or to our urgent care." Dr. Wellby then turned his/her attention to Ty. "Well, what seems to ... etc?" After an initial exam, Dr. Wellby ordered some blood work. Pat Parent and Ty were escorted to the clinic's lab, took a number along with ten other patients, and then waited some more. Ty was getting crabbier, and louder, by the minute!

Then they went back to an exam room to wait. Dr. Wellby rushed in looking for the results, which were not yet back from the lab. The doctor hurried out to see another patient, telling the nurse to see why the lab was so slow. Pat Parent and Ty waited some more ... A lab technician, who had been trying to find the right exam room eventually brought the results. The doctor determined that there was nothing seriously wrong. After writing a prescription, Dr. Wellby bade them goodbye and rushed to see the next patient. On the way out, someone at the scheduling desks asked Pat Parent if Ty needed a follow-up visit. Pat Parent didn't know because the doctor didn't say. This prompted another wait while the scheduler searched out Dr. Wellby's nurse. The nurse said, "no, but call us if

Ty's symptoms don't start improving by this time tomorrow." The nurse mumbled under her breath, "if the doctor wanted a follow-up visit s/he would have said so. Schedulers shouldn't be second-guessing him." Pat and Ty finally got home after 6:00.

Pat Parent admitted that she was especially grumpy the day of Ty's visit. Ty's getting sick and requiring medical attention meant s/he needed to leave work early. It's a new job so Pat was concerned about being away for large chunks of time, and s/he had promised to go back to work after the appointment. "It will just take an hour or so," s/he'd said. Pat feels that the clinic didn't respect her time. Pat can't afford to lose the job.

Pat resents the double standard ... While s/he's not supposed to keep the doctor waiting, they regularly keep patients waiting. Pat also didn't like it that the doctor blamed the nurse for putting them on the schedule rather than suggesting they see someone else. The nurse has been good to Pat over the years. Pat believes nurses, schedulers, everyone else gets blamed too often. If the doctor has an issue with others, whether the nurse or the scheduler, Pat thinks it's their problem and shouldn't impact customers. Pat Parent wants to be respected. If the clinic can't do a better job s/he will have to look for another doc, and tell everyone she knows to do the same.

Background Information from the Clinic Manager

At their weekly meeting, the schedulers complain to the clinic manager about Dr. Wellby and his nurse not following the standard scheduling template. We didn't "squeeze Little Ty in". According to the scheduling rules, Dr. Wellby had a 15- minute slot to see Ty. "He just works too slow, and we get blamed by his nurse and his patients." The clinic manager, who is trying to maximize each doctor's productivity, told the schedulers that she'll talk with Dr. Wellby.

Dr. Wellby told the Clinic Manager that his nurse complained about schedulers not understanding how he works, and about them second-guessing a follow-up visit. And then there are those lab people; they're so slow. They work at the same pace even when there's a patient in the exam room and the doctor is waiting for results to make his diagnoses.

At their weekly meeting with the Clinic Manager reminded the lab supervisor to
talk with doctors and nurses about using the new test order for correctly. They responded that "We worked on it for a month. There's a place to indicate when the patient is in the exam room, versus coming in from the outside just for lab work. There's even a place to indicate the exam room number, so we can get the results to the right room. The nurses are just stubborn. They think they're above doing something that makes our job easier."

At the monthly medical staff meeting, Dr. Wellby preempted the agenda to voice his concern about "cookbook medicine" to his colleagues and the clinic manager. "I practice a certain way, and my patients like it. I shouldn't be forced to see more patients in a day than I am comfortable handling. The schedulers should not be in charge of my day. And I expect my nurse to protect my schedule. If the lab and x-ray people got results back sooner, I could complete my diagnoses and send patients on their way. Something should be done about all of that!" His colleagues shook their heads in apparent agreement, but said nothing.

The clinic manager tried, for the hundredth time, to explain the importance of doctors, nurses, and other staff following the same processes. Another doctor renewed his ongoing complaint about "corporate medicine". Again, most doctors nod supportively. The clinic manager gave up in frustration. After this twenty-minute side track, the meeting proceeded to the first agenda item. After thirty minutes doctors begin leaving to see patients, leaving important agenda items to be carried over until next month.

Task

For the purposes of this homework, assume that the stakeholders are clinic patients, Schedulers, Doctors, Nurses, and the Clinic Manager. Applying the reading for this week, answer the following questions:

Question 1. Describe the process you will use to assess the stakeholders' interests and goals?
Question 2. How will you examine the larger context?
Question 3. What assessment tools will you use?