CASE STUDY A
You have been appointed as the Director of Clinical Services at a large (600 bed) metropolitan hospital – Ambrose Health. You are younger than the previous incumbent, being only 30 years of age and better qualified, having just completed a Master of Health Service Management and enrolled in a doctoral program. Most of your experience has been in smaller hospitals outside the metropolitan area. The executive management team made it clear to you at interview that they were interested in effecting change throughout the Clinical Services Division, which is why they were seeking an external appointment to the position. In particular, they were seeking an individual who could establish a cohesive and productive working team.
Shortly after commencing in the position it becomes obvious that much of what is achieved is as a result of ‘who you know’. There are many instances when the usual communication channels or procedures are not followed because of ‘system failures’ which have never been brought to anyone’s attention. When running short of stock medications, for example, many nurses contact the nursing unit manager of the medical ward as she has a ‘contact’ in the pharmacy, rather than working through appropriate channels to correct the problem. Patients in the Coronary Care Unit are routinely admitted directly to the unit rather than through the Admissions Office because it is a slow and tedious process.
When you ask why these problems have never been addressed formally, the nursing unit manager of the medical ward tells you “It has always been this way. I am a very experienced health professional – I know the system and how to get around it to get what I need to do the job properly. I see no reason to change things when I think the system is working well.”
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