1. Exercise: Preparing Your Business Plan You are considering the possibility of operating a small business or practice in some activity related to health care, as either a provider or as a service intended to support various provider organizations in their care-delivery activities. A. First, describe the kind of entity you would be establishing by stating the service or services you propose to deliver and the kinds of clients or customers you would be serving. B. Next, write a paragraph offering compelling reasons for your proposed venture, explaining why you believe it is needed and for whom it is needed. Incorporate in this narrative a description of the kind and extent of competition you might face in your intended service area and how your services would be sufficiently different to enable you to compete successfully.

2. Exercise: Promoting Total Quality Management You are a professional employed at a large urban medical center. You have been appointed to serve as a nonmanagerial member of a steering committee established to guide the implementation of TQM throughout the organization. The committee has been through a week of intensive education in TQM/performance improvement principles and has held the first two of an indefinite series of weekly meetings to pave the way for translating the TQM philosophy into practical actions that can be implemented. You are encouraged by what you have learned and experienced during these first few weeks; however, you are also conscious of the organization's past failures with management by objectives and quality circles, and you are aware of a fairly widespread tendency to regard such undertakings as dabbling in the latest management "flavor of the month." Your second steering committee ends late, leaving you only two minutes to get to your next commitment. As you leave the conference room and enter the hospital's main corridor, a colleague, heading toward the same destination as you, falls into step beside you and asks, "What's this total quality management all about? Looks to me like the same stuff that's been pushed at us in different wrappers several times over the years, and it'll probably go the same way. Nowhere. More fancy notebooks and reports that end up collecting dust. Why should we think this will be any less of a waste of time and resources?" You have less than two minutes available while on the move to provide your colleague with a positive response in a few sentences. Write out your proposed response.

3. Exercise: Choosing an Adequate Control MechanismWhat Fits Best? Refer to the chapter section titled "Characteristics of Adequate Controls." For each of the tasks or circumstances described below, recommend a specific kind of control mechanism. Your selected mechanism should provide you with information on which you can base corrective actions as needed. In each case, state why you selected that particular mechanism, describe how it satisfies the characteristics of adequate controls, and state whether you believe there are one or two additional mechanisms that might work almost as well as your chosen mechanism. -Display the status of routine scheduled preventive maintenance activities by the plant engineering department. -Track the number of repeat patient chart requests fulfilled beyond a stated two-hour response time limit. - Follow the processing of a letter of complaint from its initial receipt to the disposition of the problem. - Track the timeliness of the clinical laboratory's responses to STAT test requests. - Track the department's financial operating results as compared with the departmental budget. - Report on employment turnover throughout the organization by quarter and by year.

4. Case: With Friends Like This . . . One morning, well before the start of your department's normal working hours, you were enjoying a cup of coffee in the cafeteria, shaping up your calendar of tasks and appointments for the day, when you were approached by one of your employees. The employee, Millie Norman, one of your two or three most senior professionals in terms of service, seated herself across from you and said, "There's something going on in the department that you need to know about, and I've waited far too long to tell you." You reacted internally with both impatience and annoyanceyou were not prepared to interrupt what you were doing, and you had not even invited Millie to join you. Millie proceeded to tell you ("In strictness confidence, please, I know you'll understand why") that another long-term professional employee, Cathy Johnson, had been making a great many derogatory comments about you throughout the department and generally questioning your competence. For 10 minutes Millie showered you with criticism of you, your management style, and your approach to individual employees, all attributed to Cathy Johnson. On exhausting her litany, Millie proclaimed that she did not ordinarily "carry tales" but that she felt you "had a right to know, for the good of the departmentbut please don't tell her I said anything." Although Millie's comments were filled with "she saids" and "she dids," and generally twice-told tales without connection to specific incidents, something extremely disturbing clicked in your mind while you were listening. Recently your posted departmental schedule had been altered, without your knowledge, in a way indicating that someone had tried to copy your handwriting and forge your initials. Two separate, seemingly unconnected comments by Millie together revealed that only one of two people could have altered your schedule. Those two

people were Cathy Johnson and Millie Norman herself. As Millie finally fell silent you were left with an intense feeling of disappointment. You wondered if you could ever again fully trust two of your key employees. Instructions Write at least one fully developed paragraph in response to each of the following questions: 1. What should be your immediate response to Millie Norman? Why? 2. Do you believe you have the basis on which to proceed with disciplinary action against someone? Why or why not? 3. How can the human resource department help you in your present concern?

5. Case: Delegation DifficultiesThe Ineffective Subordinate Nursing supervisor Kate Dyer was finally forced to admit, at least to herself, that she was going nowhere in her attempt to get nurse manager Susan Foster to behave as a manager ought to behave. Summarizing the recent occasions on which Susan and her performance had come to Kate's attention, Kate had assembled the following: Whenever Kate went through Susan's unit she found Susan's desk in disarray and invariably found Susan herself behind in her work. Susan seemed to experience a great deal of difficulty in making important meetings; she had missed three of the last four nursing management meetings, and at the one she did attend she did not show up until it was half over. Kate's specific suggestions as to tasks that Susan might consider delegating to some of her subordinates have apparently been ignored. Some weeks earlier Kate had asked Susan for a detailed written list showing how the various nursing duties on her floor might be divided among the unit's staff members. Susan did not comply with the request. In general, Susan seemed to have but two answers for many of the questions put to her by peers and supervisors alike. To questions that were general and nonthreatening, such as "How is everything going?" she would simply answer, "Just fine." However, if a question seemed intended to determine why something had not been done, Susan could be counted on to answer, with a pained expression on her face, "I simply haven't been able to get to it." Questions: 1. Although Susan's performance is obviously lacking in a number of ways, Kate might best begin by examining some elements of her own performance and her own leadership style. What are the elements of the case that may have prompted this statement, and what are the implications of those elements regarding Kate's style and performance? 2. What appear to be the weakest elements in Kate's style? Why are they weak? 3. Assuming that Kate is able successfully to address the deficiencies in her own approach to management, where should she begin in trying to determine if Susan has the potential to become a truly effective nurse manager?