Reference no: EM132909600

Midwest Hospital Policy and Procedure Case Study

Herb Davis was hired by Midwest Hospital to manage their Family Practice Clinic. Dr. Davis was raised and educated in England. After completing medical school there, he moved to Canada where he practiced medicine in a rural area for several years. After some years as a practicing physician, he developed an interest in academic medicine.  He then moved to the U. S. and was the director of three family practice residency training programs before coming to Midwest Hospital.  Davis brought to Midwest Hospital considerable administrative experience, which was unusual for a physician.  Dr. Davis was very successful at helping the Family Practice Clinic grow and expand its services. The competition for patients was intense in the community where the clinic was located. Dr. Davis' success was not a small achievement.

Part of this success was Dr. Davis' sensitivity to the problems and stresses of others who worked in the clinic. Dr. Davis was always supportive of his medical staff in particular. One example of this was a young physician, and mother of two small children, who experienced a particularly messy divorce. Dr. Davis was supportive of this physician and did as much as he could to allow her flexibility in the hours she worked. He allowed her considerable time away from the clinic to attend to personal matters.  But Davis was also quite analytic in his approach to managing the clinic.  He believed that good organizational structure was one of the keys to successfully managing a medical clinic.  One of the first things Davis did was make a Management Committee.

Once a week, Dr. Davis met with the Management Committee, composed of all the department heads in the clinic, to discuss and develop policies related to management of the clinic. Membership included Dr. Davis, his assistant, the clinic office manager, the nursing supervisor, and two physicians-one who represented the six full-time members of the medical staff and one who represented the part-time physicians who staffed the urgent care center.  At these meetings, a wide range of policies and issues were discussed. Dr. Davis clearly had the final say on any policy, but he was eager to hear the opinions of all the members of the committee and he created a meeting environment where those in attendance were allowed to express their opinions freely.  Sometimes, there were very contentious and frank discussions of issues. The intention was that the Management Committee would develop polices and once a policy had been formulated and agreed upon, the members of the group would communicate it to their respective subordinates. Through this process, policies were to be incorporated into routine clinic activities. 

One issue that desperately needed to be addressed was the issue of physician appointment schedules. The clinic had both a regular staff of physicians and a walk-in urgent care center.  The problem was that the urgent care operation was often understaffed.  The urgent care center was largely staffed with family practice or internal medicine residents who were "moonlighting."  These physicians were sometimes late to the clinic because of other responsibilities, and they generally could not work as fast as more experienced physicians.  This often caused the urgent care patient flow to "back-up."  To relieve this problem, clinic staff would sometimes add urgent care patients to the schedule of the regular physicians for whom the clinic was where they primarily practiced medicine.  This was very disruptive of the operation of the clinic.  The staff physicians didn't like it as it would throw them off schedule if they had even just one or two "work-ins."  They complained to Dr. Davis about this and he agreed to take it up with the Management Committee.

Before he took the issue to the Management Committee, Dr. Davis gathered some data with the help of the clinic office staff:

• The urgent care clinic is open 10:00AM until 10:00PM Monday through Friday and 11:00AM to 7:00PM weekends
• The clinic is budgeted for 50 hours of locum tenens weekly to staff the urgent care clinic
• There are two physicians on duty on the weekends so that uses 16 of the budgeted 50 hours. The other 34 hours of physician time are spread over the weekdays.
• On weekdays, most of the urgent care patients are seen after 3:00PM.  More urgent care patients are seen later in the week (Wednesday, Thursday and Friday), rather than earlier (Monday and Tuesday).

Dr. Davis has three issues he wants to take to the next Management Committee meeting:

• Should the uncommitted 34 hours of budgeted physician time for the urgent care be allocated to the three weekdays that are the busiest?
• If it is decided to do that, it would leave only the full-time physicians to staff the urgent care center on Mondays and Tuesdays.  Should the full-time physician's schedules be adjusted to cover the two evenings (Monday and Tuesday) in the urgent care center?
• How could a balance be achieved between having appointment times for the full-time physicians to see their established patients but also have time to see urgent care patients?

Questions

1. Which of the three issues Dr. Davis is taking to the Management Committee are procedural decisions and which are policy decisions? Be sure to explain your answer.

2. Write policy statements for those of Dr. Davis' issues that pertain to polices and write procedures for those issues that pertain to decisions that are procedural.