ASSESSMENT 4 – both case studies are to be addressed
Case Study A
You have been appointed as the Director of Clinical Services at a large (600 bed) metropolitan hospital. You are younger than the previous incumbent, being only 30 years of age and better qualified, having just completed a Master’s degree and enrolled in a doctoral program. Most of your experience has been in smaller hospitals outside the metropolitan area. The Executive 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 reply is along the lines of “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.”
All questions are to be answered
1. How would you respond to this comment?
2. Identify some personal goals for yourself given the situation described.
3. Outline what you perceive to be the major driving and restraining forces for change and strategies for dealing with these.
4. Determine some strategies for initiating change and methods of unfreezing and refreezing.
5. As a percentage, what chance would you give yourself at success in this organisation in the next two years and why?
Case Study B
You are a community health worker who has recently been awarded a grant from the commonwealth department of health for three years to establish a drug education program in an inner city suburb which is a known gathering point for drug addicts. The goal is to decrease rates of HIV/AIDS and hepatitis but more importantly, to decrease rates of drug use and overdose. The project will be evaluated at the end of the grant to determine whether continued funding is warranted. As project director, you have the funding to choose and hire four additional employees and manage the program as you desire.
The average age of those likely to use the service is 15 years, and most live on the streets. This suburb is known to have a high crime rate. Police patrols are more frequent than in previous years but petty theft, burglaries, assaults and prostitution are common. High unemployment rates are a feature of this suburb.
The local community has just been advised that the project is to commence shortly. They are becoming increasingly ‘agitated’ about the effects that the introduction of such a program may have on their local area. While accepting that there is a high proportion of drug addicts frequenting the area at the moment, they are concerned that raising the awareness of this community as a ‘safe haven’ may encourage even more individuals to congregate in the area, particularly during the day. The state department of health has endeavoured to counter this argument by organising several open forums where the issues can be discussed and fears allayed. This seems to have encouraged open debate but diminished acceptance of the proposal.
There are three primary schools in close proximity to the proposed site and a private co-educational high school two blocks away. It is the parents of children attending this school who appear to be most vocal. Their objections have increased since two children were expelled for drug-related offences. The local churches have thus far not contributed to the debate nor ventured any opinion on the proposal. To date, they have not become involved in providing any type of ‘social welfare’ to those who call the streets ‘home’.
All questions are to be answered
1. Identify the restraining and driving forces. Determine some strategies that will increase or decrease these forces as appropriate.
2. Identify the strategies for initiating change and methods of unfreezing and refreezing.
3. Identify short and long-term goals which are realistic and achievable for the three year period in relation to:
(i) the organisation
4. What sort of staff could you employ to increase the driving forces?
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