Leadership: Case study

A foodservice management company provided the following management and professional staff to a community hospital: the foodservice director (FSD), an assistant director for patient services (ADPS), an assistant director for nonpatient services (ADNS), a production manager (PM), 3.4 clinical dietitians, and 3.0 foodservice supervisors. The dietetic technicians, diet clerks, and foodservice workers were employed by the hospital. Weekdays, the staff included the FSD, ADPS, ADNS, PM, three clinical dietitians, two dietetic technicians, and two foodservice supervisors. Weekend staffing consisted of one clinical dietitian, one dietetic technician, and two foodservice supervisors. The contract management company was new to the account. The clinical dietitians felt they had very little clinical work to do on Sundays and that, therefore, they should not have to work on Sundays. Their manager, the ADPS, was a consensus manager. She agreed with the clinical dietitians that the workload on Sundays was light, and that many of the tasks the dietitians performed on the weekends were either technician tasks (such as calorie counts and screenings) or foodservice tasks (such as food substitutions and production issues). When the subject was introduced in a staff meeting, the group decided the issue should not be addressed at this time because the contract was new and any proposed change might be interpreted as a cut in service. There was agreement that to move forward with such a proposal, hard data were needed to substantiate the anecdotal information the clinical dietitians had gathered to describe their weekend workload. Thus, the clinical staff members agreed to keep productivity records on Saturdays and Sundays to determine what they actually did on weekends. They designed a form to record all of the tasks the clinical dietitians performed on weekends. Ten months later, when the management company was secure with its position within the facility, the issue again appeared on the agenda. Data indicated that clinical dietitians performed, on average, 0.3 nutritional assessments, 2.1 kcal counts, and 3 screenings on Sundays. The rest of their day was spent catching up on office work, resolving foodservice issues (4.2 each Sunday), or reading journals. Interestingly, Saturday activities were similar. Average tasks performed included 1.2 discharge instructions, 2.4 kcal counts, and 1.8. On most Saturdays, no nutritional assessments were done. It was also determined that the dietetic technician could have done the kcal counts and the screenings if the dietitian had not been there, and that foodservice supervisors would have resolved the foodservice issues if the clinical dietitian was not present. The weekend tasks that actually required a registered dietitian averaged 1.2 discharge instructions on Saturday and 0.3 nutritional assessments on Sunday; these tasks required less than two hours of RD time on Saturday and about thirty minutes on Sunday. It was also noted that many of the discharge instructions could have been anticipated and performed on Friday, had the dietitians chosen to complete them. The staff members often delayed instructions that could have been completed on Fridays so there would be something to keep them occupied on Saturdays. Based on the accumulated data, the clinical dietitians again requested Sundays off. And again, the ADPS agreed, but added there was an equally compelling argument for scheduling Saturdays off, too. Indeed, clinical dietitians were underutilized on both weekend days. Discussion followed. One dietitian argued the workload on Fridays and Mondays would increase if they were to take both days off. The ADPS argued that the proposal had to be approved by both the medical staff and the hospital administration, and that the request might be only partially granted. Asking for both days off would provide room for negotiation, which would increase the chances of getting at least Sunday off. One clinical dietitian wanted to request every weekend off, one wanted to request only Sundays off, and the other 1.4 clinical dietitians were undecided. The group could not reach an agreement, and the matter was tabled until the next clinical staff meeting. During the next staff meeting, the question of weekend work was again on the agenda. The arguments were essentially the same, and the group was unable to reach consensus. At this time, one of the full-time clinical dietitians still chose to request every Saturday and Sunday off, and another was uncertain about what position to take. The idea of weekends off was enticing, and the risk of getting neither day off was a problem for her. Now, however, 1.4 clinical dietitians expressed opposition to having, or even requesting to have, the entire weekends off. The item was tabled again, for lack of consensus. At the following staff meeting, the issue remained unresolved and was tabled again. The Medical Staff Committee, which oversees clinical nutrition services in this hospital, was scheduled to have its quarterly meeting in three weeks, and it was necessary for the proposed change to be approved by this committee before the matter could be taken to the hospital administration. The ADPS knew about this meeting and informed the staff members. She asked them to try once more to reach consensus, but they could not. Therefore, she announced she was making the decision to move forward with the request for Saturdays and Sundays off for the clinical dietitians. It was, she said, a management decision based on the productivity figures it had gathered. The ADPS also told the staff that, if both weekend days were granted by the medical staff and the hospital administration, the issue would be revisited in six months to evaluate how the change was working and to consider changing staffing patterns again if the Friday/ Monday workload was too great. One dietitian protested vigorously that the manager was not being democratic, because only one of the dietitians wanted the weekends off and 1.4 dietitians wanted only Sundays off. Because the other full-time dietitian was still undecided, she reasoned, the vote was 1 to 1.4. She believed the ADPS should not have a say in the discussion because she did not work on weekends.

The ADPS informed staff members that, despite the protests, the workplace was not required to be a democracy and that the management decision was made. She stated she was sorry that the group had not reached consensus, but that time did not permit her to delay the decision any longer. She made her recommendation that clinical dietitians should no longer work weekends to the Medical Staff Committee at its next meeting.

Questions:

1. Why did the ADPS seek consensus?

2. Was the ADPS being autocratic when consensus was not reached?

3. Did the ADPS have the right to make the decision?

4. Did the ADPS have the authority to make the decision?

5. Did the dietitian who protested have a valid argument when she said the manager was not being democratic?

6. Was the staff being manipulated into reaching consensus on a decision the ADPS had already made?

7. How do you think things would evolved if all 3.4 clinical dietitians had reached consensus to request only Sundays off?

8. Should the ADPS have had a voice in the decision although she did not work weekends?

9. Would it have been better for the ADPS to make no decision at this time but continue to seek consensus?