Few industries are confronted with more change and more turbulence than the health care industry. As the perusal of any newspaper or news website will indicate, there is constant pressure on health care organizations to provide quality care in a cost-controlled environment that is characterized by ever-increasing regulation. This pressure can be seen most clearly in the advent of “managed care” during the 1980s and beyond. Managed care involves integrated and comprehensive systems of health care providers, insurance companies, and government programs, coordinated around specific care plans and guidelines designed to simultaneously enhance the quality of care provided, control the cost of that care, and maintain access to care for as many people as possible. As you might guess, it’s pretty much impossible to succeed in all three of these important goals of cost, quality, and access, but hospitals and other health care organizations keep on trying. I’ve run into many such organizations in my research on communication in health care organizations. One of these organizations—we’ll call it University Hospital— is discussed in several of my publications (Miller, 1998; Miller, Joseph & Apker, 2000). University Hospital is a large teaching hospital that employs nearly 5,000 individuals and is responsible for half a million patient visits a year. University Hospital is acknowledged as a very high-quality medical center—for example, it typically scores extremely well on accreditation surveys. However, like all health care organizations, University Hospital needed to improve in a number of financial areas, including average length of stay and cost per discharge. My involvement with University Hospital began when I learned of changes that were occurring in the nursing department and was asked to be a part of understanding and instituting those changes. As part of a hospital-wide effort to improve financial and care performances, the nurses were beginning a program of “differentiated nursing practice” (Hoffart & Woods, 1996) in which nursing roles were defined on a variety of specific levels of responsibility. These roles would require new training, new responsibilities, and a new orientation toward the systematized provision of care. The centerpiece of this program was the “care coordinator” role. 

CASE ANALYSIS QUESTIONS

1. How does the nursing department at University Hospital exemplify ways that organizations often react to planned organizational change? Are there ways in which the nature of the change— or the way it is being instituted at University Hospital—differs from traditional patterns?

2. If you were taking on a “care coordinator” role at University Hospital, what kind of information would you want to have? Do you like the idea of an unstructured role that you can develop on your own? What are the advantages and disadvantages of this kind of organizational ambiguity? 

3. How would you choose to lead this department through the change they are experiencing? Would you rather have Jen or Hannah as your leader in this process? 

4. What are some ways that Jen and Hannah could work together to make the change process successful?