I need someone to answer this by drawing a diagram Which system archetype could be used to represent a core issue in this scenario? Please describe this system and its dynamics as it applies to this scenario in your reply, and create and attach a fully labeled system archetype diagram to illustrate it

Lincoln Hospital: Third Party Intervention

Soon after the election of a new chief of surgery, the president of Lincoln Hospital faced a crisis. Lincoln, a 300 bed for-profit hospital in south-western United States, was experiencing severe problems in its operating room (OR). Forty per cent of the OR nurses had quit within the previous eight months. Their replacements were significantly less experienced, especially in the specialty areas. Furthermore, not all could be replaced; when the crises came to a head, the OR was short seven surgical nurses.

Also, the necessary equipment often was not available. On several occasions, orthopaedic surgeons had already begun surgery before they realised the necessary prosthesis (for example, an artificial hip, finger joint or knee joint) was not ready, was the wrong size or had not even been ordered. Surgery had to be delayed while equipment was borrowed from a neighbouring hospital.

Other serious problems also plagued the OR. For example, scheduling problems made life extremely difficult for everyone involved. Anesthesiologist's often were unavailable when they were needed, and habitually tardy surgeons delayed everyone scheduled after them. The nursing shortage exacerbated these difficulties as the lack of staff required impossibly tight scheduling. Even when the doctors were ready to begin, the scheduled nurses might still be occupied in one of the other operating rooms.

The surgeons were at odds among themselves. Over 30 of them were widely regarded as prima donnas who considered their own time more valuable than anyone else's and would even create emergencies in order to get 'prime time' OR slots - for which they were often late.

Worst of all, the doctors and nurses were virtually at war. Don, the new chief of surgery, was at war with Mary, the veteran OR director; he had even campaigned on a promise to get her fired.

Lincoln's president was faced with a difficult choice. On one hand, he needed to satisfy the physicians, who during the tenure of his predecessor had become accustomed to getting their way in personnel matters, by threatening to take their patients elsewhere. The market was increasingly competitive, and the hospital was also faced with escalating costs, changes in government regulations, and strict Join Commission on Accreditation of Hospitals standards.

Could the president afford to alienate the surgeons by opposing their newly chosen representative - who had a large practice of his own?

On the other hand, could he afford to sacrifice Mary?

She had been the OR director for 13 years, and he was generally satisfied with her.

As he later explained;

Mary is a tough lady, and she can be hard to get along with at time. She also doesn't smile all that much. But she does a lot of things right. She consistently stays within her budget...

Furthermore, whereas Don had long been an outspoken critic of the hospital and was generally distrusted by its administrators, Mary was loyal, a strict constructionist who adhered firmly to hospital policies and procedures:

She is supportive of me, of the hospital, and of our interests. She doesn't let the doctors get away with much. She has been an almost faultless employee for years, in the sense that when she comes to work, gets the job done, never complains, and doesn't make any waves. I really don't understand the reason for the recent problems. I trust her and want to keep her. It would be extremely difficult to replace her.

The last point was a key one; a sister hospital had spent almost three years trying (unsuccessfully) to recruit an OR director.

After talking with both nurses and doctors, the president decided not to fire Mary. Instead, he told both Mary and Don that they must resolve their differences. They were to begin meeting right away and keep on meeting, however long it took, until they got the OR straightened out.

The results were predictable. Neither party wanted to meet with the other. Mary thought the whole exercise was pointless, and Don saw it as a power struggle that he could not afford to lose. The president, who wanted an observer present, chose Terry, the new executive vice president and chief operating officer. Mary didn't know Terry very well so she asked that her boss, the vice president of patient services, sit in. Don, who didn't trust either Mary or her boss, countered with a request for a second of his own, the vice president for medical services.

When the meeting finally occurred, it quickly degenerated into a heated argument, as Don and Mary exchanged accusations, angrily defended themselves, and interpreted any interventions by the three 'observers' as 'taking sides' or favouritism.

At this point, Lincoln's president called me. We negotiated a psychological contract, where the president share the above historical information, described the problem as he saw it, and identified his expectations of me and for the project. Then, I expressed my expectation of the president. When then agreed to take no steps until I had interviewed both Don and Mary.

Later that afternoon, Don expressed his anger and frustration with the hospital administration and, most of all, Mary:

I don't want to have anything to do with this lady. She is a lousy manager. Her people can't stand to work for her. We don't have the equipment or the supplies that we need. The turnover in the OR is outrageous. The best nurses have quit, and their replacements don't know enough to come in out of the rain...All we want is to provide quality patient care, and she refuses to let us do that. She doesn't follow through on things.

He particularly resented Mary's lack of deference.

Mary's behaviour is so disgraceful it is almost laughable. She shows no respect whatsoever for the physicians...She thinks she can tell us what to do and order us around; and I am not going to put up with it any longer. When I agreed to take this job as chief of surgery, I promised my colleagues that I would clean up that mess that has plagued the OR for years. I have a mandate from them to do whatever is necessary to accomplish that. The docs are sick and tired of being abused, and I am going to deal with this lady head on. If we go rid of her, 95 per cent of our problems would go away. She has just gone too far this time.

In his cooler moments, Don admitted that Mary was only partly to blame for the OR problems, but he still insisted she must be fired, if only to prove to the doctors that the hospital administration was concerned about those problems, and that something was being done. I am always a bit suspicious about the objectivity of someone who has reached the conclusion that someone must be fired. There is always something else that is going on that requires more investigation, such as personal bias perhaps.

Clearly, both Mary and Don had strong needs to control other people's behaviour, while remaining free of control exacted upon themselves.

It was obvious from these initial interviews that Don and Mary were largely contributing to the OR problems; but it was also obvious that many others had a stake in the outcome of their battle.

Most of the doctors blamed the high turnover on the nursing managers' inability to retain qualified personnel, whereas the managers blamed it on the doctors' verbal abuse. A significant number of doctors were widely regarded by some of their peers as well as by the nurses as impatient, intolerant perfectionists who demanded for higher standards of others than they did of themselves.

The next step was to identify specific problems for Mary and Don to address. They wrote their response on a sheet of paper, assigning directions to represent the relative seriousness of the problem. Some of the most serious problems could be solved immediately; others were going to take longer, but at least Don and Mary now knew what their priorities had to be.

Finally, it became possible for them to agree on specific behavioural changes that might help. Don and Mary each defined what they wanted from the other and negotiated what they themselves were willing to undertake; the meeting was moderated and they wrote down the decisions. Since Mary and Don were interdependent, either could have easily sabotaged the other's efforts. Therefore, in defining each action item, they were reminded to specify responsibilities for both parties:

What will Don (Mary) do to resolve this problem?

What will Mary (Don) do to help the other succeed?

This technique made both parties jointly responsible for resolving each problem and thus changed the whole dynamic of the relationship - from mutual isolation to collaboration, from denial of responsibility to acceptance of responsibility, and from a focus on problems to a focus on solutions.

During the next year, there were four more meetings with Don & Mary. Before each meeting, each participant was interviewed privately. At the beginning of each meeting, the participants gave general reports on what was going on, between Mary and Don and in the OR in general. In particular, each one was asked to list positive events and specific behaviors on each other's part that they appreciated. They then reviewed the commitments they had made during the previous meeting.

In almost every case, both Mary and Don had kept these commitments, thus building a basis of trust for further commitment during the latter part of the meeting. Where they had not kept the commitments, plans were made to ensure follow-through before the next meeting.