After reading the Opening Decision Point case study (Hartman, DesJardins, & MacDonald, 2021), Am I About to Lose My Job? and the four villains can some one please help me with this

• Apply the decision-making process to help determine what you would do, then answer the following questions:
  • Which villain(s) (Heath & Heath, 2013), could potentially impact your decision?
  • How might you guard against this/these villains?
• craft a written reply to the receptionists email.

Am I About to Lose My Job? What Would You Do?

You work for a company that is one of the major health care providers in the region. The company operates a large hospital and

numerous medical offices and clinics throughout the area. Your own background is in accounting and you have worked on the business

side of health care for fifteen years.

Like many other industries, health care is going through a period of significant consolidation, driven largely by increasing specialization within medicine and ever-increasing costs, especially of diagnostic and treatment technologies. Given your background in accounting, you fully appreciate the economic argument for consolidation in this field. You have firsthand experience with major cost

savings created by efficiencies in patient record keeping, scheduling, and, especially, insurance administration and reimbursement.

However, you also believe that consolidation is in the patients best interests as well. Once integrated into a regional medical system, patients will have greater access to specialized care and treatment, while economic efficiencies help keep costs low as well.

Two years ago, as part of its strategic plan, your company acquired another smaller health care company that operated a number of clinics in rural towns across the region. In most cases, these clinics are the only health care provider in town. A typical clinic is staffed full

time by several clerical and administrative workers and several nurses with advanced diagnostic training and a license to prescribe medication. A physician is on-site several days each week. Much of the day-to-day work at the clinics involves routine medical procedures: diagnosing and treating minor illnesses, advising on wellness care, and providing routine checkups and examinations. More serious or complicated cases are scheduled when the physician is on-site, or referred to specialists at larger health care facilities. Your own work during most of this period has been to help these individual clinics integrate their own accounting procedures and administrative operations into your companys system. You have spent time working and getting to know the employees at each of these

clinics. At first, you sensed that they perceived you as an outsider who posed some threat to local operations. Employees understood that, as often occurs in many acquisitions, there was a chance that some people might lose their jobs and even some clinics might close.

Nevertheless, they soon realized that your work was aimed to help them integrate their operations into your companys system, and over time you succeeded in creating relationships of trust and mutual respect with many of the employees.

More recently, however, you have been asked to assist senior management in analyzing the longer-term financial viability of each individual clinic. Based on previous acquisitions and the companys strategic plan, you believe that the least profitable of these smaller clinics will be closed and the more profitable ones will expand. In all cases, much of the administrative side of the clinicsrecord-keeping, scheduling, and insurance processingwill be consolidated with the central office. All of the reasons that explain the move towards consolidation in general make equal sense on the local level. Economic and operational efficiencies make a strong case for following this

strategy. You know that if this consolidation happens, the health care professionalsall of the nurses, physician assistants, and the physicianswill be offered positions at other clinics, but most of the other employees will lose their jobs.

As a result of this change in assignment, you have noticed that the nature of your relationship with the employees at the clinics has begun to change as well. Part of this, no doubt, stems from your own hesitance. Knowing that some people will lose their jobs as a result of your recommendations, you have tried to remain somewhat aloof, have been reluctant to join in conversations, and have declined

invitations to lunch. The information that you are requesting and the questions you are asking are also beginning to raise suspicions among employees.

After a recent visit to one clinic, you receive an email from the office receptionist. She begins by telling you that based on your previous work relationship, she thinks that she can trust and confide in you. She then reminds you how important the clinic is for the local town. She points out that the majority of the cases they treat involve children and the elderly, and that they know most of their patients on a first-name basis. The clinic provides the type of personalized health care that is increasingly unusual in a large system. Finally, she tells you that the office is full of rumors that the clinic is about to be closed. She explains that there are few jobs in this small rural community

and that she is worried about losing her job. She then tells you that she knows of another job, but with lower pay and fewer benefits than her present job. She asks you directly if the clinic is likely to be closed. She concludes by asking: Am I about to lose my job? Should I pursue this other job

Villain # 1: Narrow Framing. Narrow framing means that you are not considering all the alternatives available to youyou are defining your choices too narrowly. Narrow frame thinking would be when you are asking yourself if you should take a certain action or not, or which of two actions would be better. For example, should you fund Agency A or Program B? Should you emphasize early childhood or High School graduation? Restricting yourself to two choices limits your alternatives. You may not even consider options that would be better.

Villain # 2: Confirmation Bias. Confirmation bias means that when you want or believe an idea to be true, you pay more attention to the information that supports that belief. People naturally tend to select information that supports their preexisting attitudes, beliefs and actions. This is why in working differently communities, we see a sequencing of data gathering which flows FROM discussions of what we as a community want to achieve or what we aspire to become rather than take up a lot of data gathering about the present state. Because that data picture of the present state tends to be narrow frame (problem rather than solution) and bias toward what we already are doing. How many "fact finding" surveys conclude with the need to fund more of what we are already doing? "Working differently" habit #6 is most helpful here: choose measurable outcomes.

Villain #3: Short-term Emotion. Short-term emotion will pass and is not useful in making a long-term decision. Short-term emotion clouds thinking. When you are emotional about a decision, you might replay arguments over and over until you cant think straight, even though the facts have not changed. You may also only be thinking emotionally, such as wanting a red sports car that is impractical for you in the long run. In a community systems context, this can be seen as defensiveness. Good people, doing good things who, while hampered by the present system from getting good results, feel put upon by "new-comers" asking why "you" aren't achieving certain results. This tends to perpetuate a cycle of blaming things actually, or perceived to be, outside of these good people's control. Which then tends to create a lot a busy work about what is presently being done rather keeping the focus on what needs to be done differently across the community. It is only in a "safe" place where folks who have been doing the community's heavy lifting are respected and see that clarity regarding the shared outcome is a full answer to their prayers for resources and tools all aimed at moving the needle on the outcome. This is the shared we're-all-in-this-together buoyancy provided by the working differently habit #5: avoiding the blame game.

Villain #4: Overconfidence. Overconfidence is believing that you know what the future holds. Some years ago people generally believed the Internet would never catch on and no one would pay for television programs. Many years ago people were confident the earth was flat. In everyday life it might be that you are absolutely positive that a certain philosophical or ideological banner is the right one for you (even though there is no meaningful evidence that it achieves the desired state) or that getting into a certain grant is the only way to achieve your goals. Being overconfident leads to not considering alternatives or what might happen if your choice doesnt work out well. Being overconfident about the future can lead to unfortunate outcomes. That is why the final habit of highly successful communities is so telling: develop a sense of urgency and keep going. You are on a journey to discover what you don't know about achieving transformative change. You are passionate about getting there and you are humble about knowing that tomorrow you will know more than today ...