LEARNING GOALS

This case will help you learn to develop an action plan and evaluate multiple competing objectives during a complicated organizational period: a company merger. As a co-manager and confidant of a project manager tasked with bringing efficiency and a vision to a newly merged hospital system, you will be providing mentoring advice on how to approach a delicate situation and one that is sure to upset some employees. After reading the case, you'll prepare a memo that outlines your thoughts for how you would proceed as a leader tasked with creating a new culture that must come together quickly in order for the unit to survive.

KEYWORDS COVERED

Task performance

Affective commitment

Trust

Escalation of commitment

Leadership

Power

Matrix structure

Organizational culture

THE SITUATION

Sitting across the table, Colleen Brooks looked excited and yet discouraged at the same time. It seemed to be a strange combination of emotions, but it was a look you had come to recognize over recent weeks among managers you had grown to admire over the last few years. Colleen spoke somewhat softly, "I'm just not sure what I'm supposed to do here. I've been put into this position where I feel I can really make a difference in a lot of ways, but I also feel like the deck has been stacked against me. These people just don't trust us yet, and I'm not sure given the situation that I can blame them. It's partially their fault, though! Had Medical One run its business well to begin with, there's a good chance we wouldn't be here."

Medical One was the largest multispecialty health care practice in the northwest part of the United States. It had numerous regional clinics across several hospitals in seven states and employed more than 13,000 employees and 900 physicians in addition to running its own insurance plan. In many ways, Medical One would seem to outsiders as a model health care provider. Internally, though, Medical One was in severe financial distress. Cost overruns and bad planning had placed the company under a great deal of debt. This debt allowed Healthcare Plus, a much smaller (4,600 employees) but more financially sound practice operating throughout Arizona and New Mexico, to acquire Medical One by taking over and restructuring its financial situation.

Although health care mergers and acquisitions were becoming more and more commonwith 243 deals totaling $73.5 billion taking place in the second quarter of 2011 aloneit didn't make the process any easier for those companies involved. The merger between Healthcare Plus and Medical One had many potential advantages but carried with it a certain amount of risk as well. There was great resentment among the employees of Medical One (some of whom had been with the company since its inception in 1992) that a smaller company could come along and just "purchase" them. Medical One had grown quickly and was known in its area of the country for providing extremely high-quality health care services. Everything they had read or heard through the grapevine about Healthcare Plus was oriented around cost-cutting and to most employees at Medical One, lower costs equated to lower-quality health care.

Colleen was not happy about the way management had decided to restructure the two companies following the merger. In order to try to get the best out of both companiesnamely, Medicare One's customer service focus and Healthcare Plus's efficiency and cost containmentthe top management team had decided to create a matrix structure to operate under going forward. For the most part, managers at Medical One would continue to report to the same functional directors they had before. However, each manager would now report and answer to another director as well. The "new" directors were supposed to be region-based efficiency experts. Colleen, who had been a highly successful manager of nursing in one of the largest Healthcare Plus clinics in Santa Fe, New Mexico, had been tapped as a new "Regional Director of Nursing Efficiency." "What a miserable job title!" Colleen thought when she originally heard the news. At the same time, this was a big promotion for her and the change would be very positive in many ways for her and her family.

Colleen's job was to oversee nursing operations in four statesNew Mexico, Colorado, Utah, and Wyoming. Of the 14 nursing managers she was supposed to supervise, 11 ofPage 547them were at Medical One facilities. (The company decided not to change the "Medical One" name after the merger for marketing and continued branding purposes.) Fundamentally, Colleen knew that the reasoning behind the new structure was to blend Healthcare Plus's management style and expertise with Medical One's scale of operations. Although upper management was trying to sell the acquisition to everyone inside the organization as a "merger" of two great companies, almost all of top management came from Healthcare Plus.

Colleen had decided that the first meeting with her new managers was an important one, and she decided to bring them all to Denver, which was a relatively central location but also where one of Medical One's largest hospitals operated. She took great care in personally phoning each manager, introducing herself, and letting them know that she was looking forward to working with them. Some of those managers were quiet and hesitant over the phone, but some seemed very open and receptiveeven excitedabout the possibility of working together to make things better. Sarah Stoneford, a nursing manager in Cheyenne, Wyoming, even told her that she had been waiting for something like this to happen because "the amount of waste I see around here on a daily basis would make anyone cringe in disbelief."

In order to make everyone feel more equal, Colleen had arranged for the meeting to take place in a Denver hotel. Having the meeting in the Denver hospital just seemed too constricting somehowshe wanted everyone to keep as open a mind as possible. Plus, Jim Liucci, the nursing manager at the Denver hospital, had already shared that his nursing director was not excited about the changes that were coming, and Colleen wanted him to feel comfortable in speaking to the group and not looking over his shoulder. While on the phone call with Jim, Colleen thought, "His operational director doesn't even know what changes are coming! How can she be upset about things that haven't even happened yet?" but she didn't want to say anything until she and Jim had the opportunity to meet in person.

Initially, getting together with everyone went extremely smoothly. All 14 managers had arrived on time the night before, and some had even eaten dinner together and hung out in the hotel bar getting to know one another better. Even though 11 of the managers had worked for Medical One, even occupying the same jobs, they had actually never met one another before. Colleen was pleasantly surprised to see all of them having a good time and being excited about meeting one another. When she laid her head on her pillow that night, Colleen thought to herself, "These people are thirsty for change! They recognize that Medical One has issues that need to be addressed and it's simply my goal to push them in the right direction toward accomplishing our objectives."

The next morning didn't go nearly as well. Every time Colleen mentioned a potential idea that had reduced costs effectively at Healthcare Plus, it was met with a "that will never work here" type of answer. After several rounds of this, Colleen's frustration seemed to mount. When the Healthcare Plus managers tried to chime in with evidence that these types of procedures had worked for them in their facility, the Medical One managers seemed to form ranks. It wasn't until it was too late that Colleen noticed the three Healthcare Plus managers were all sitting together at the large U-shaped table, a seating arrangement that didn't seem to be helping things. At one point, Donna Mitchell, a Medical One nursing manager in from Provo, Utah, even went as far as to say, "I know that kind of stuff might work in New Mexico, but our patients expect a better level of care." Todd Rappen, a manager in Grand Junction, Colorado, was even bold enough to comment that if cost savings were such a big deal, why was the group paying to rent a hotel meeting room instead of using one of the Denver hospital's conference rooms? Colleen knew at that point that things had gone terribly wrong.

Although it was clear to Colleen that many of the managers were resistant to the ideas she discussed throughout the day, most of them placed the blame on their local nursing directors for their unwillingness to change. This allowed her new reports to be able to nod their heads in agreement personally, but introduce negative opinions without fear of recrimination. As the meeting closed, Colleen tried to assure the group that this was just the first step of many on a long road to making a successful situation for everyone. She tried to set an upbeat tone, but it was clear that many people had been upset by some of the things that were said during the meeting. There was definitely an "us vs. them" mentality as everyone left the room to catch flights or hop in their cars.

Colleen had just now begun to grasp the realities of not being in a location with her direct reports. There were many new things she would have to get used tomanaging managers, managing remote individuals, managing people who also report directly to other managers they were more familiar with at their locationin essence, her job was to lead with seemingly very little power. What she wouldn't have to get used to, though, was upper management expecting her to make changes at these locations that would create bottom-line results in a short period of time. The good thing is that she had lots of experience doing just that. "I know that we have made many excellent changes at Healthcare Plus without sacrificing patient careI just have to get others to open up to that idea," Colleen thought on the plane ride home.

As you listen to Colleen, it becomes apparent to you that she is beginning to question her ability to be able to do this new job effectively. Although you have been in leadership development training programs together, the fact is that leadership is much easier when things are going well for a company. Although there are many potential areas of improvement for the new company going forward, it's clear the road is going to be difficult. Colleen's voice suddenly lowered as she started to pack up her things, "Look, I asked you here today to be a sounding board of sorts, but the truth is I could really use your advice. I don't need an answer right now, but if you could givePage 548me your thoughts on things I could do to be a better leader at this point I would appreciate it. You've always given me good advice in the past."

YOUR TASK

Your task as a leadership mentor to Colleen is to prepare a memo that lays out your thoughts on her situation and some specific courses of action she should consider as she attempts to start leading her new group. Make sure to give her a memo with enough detail so that she understands the reasoning behind your recommendations. Also keep in mind the order in which she should follow these steps. In particular, your memo should touch on the following points.

1.Drawing on what you know about leadership, what types of behaviors are going to be most important for Colleen as she begins to interact with her new direct reports. Should these behaviors change over time?

2.What kinds of power can Colleen use to try to influence others to adopt some efficiency related procedures? Are there certain types of influence behaviors that will be more effective than others given the difficult circumstances?

3.It's clear that the two companies have very different cultures even though they are both health care providers. Should one culture be stressed over the other? Will this affect the way Colleen should lead the group?

4.What does Colleen have going for her in terms of getting others to trust her? Are there certain things she should do or say to generate that trust as well as maintain it over time?

5.How does the new structure affect Colleen's ability to lead? It would be useful to detail some of the pros and cons Colleen will likely face given how things have been organized.

6.Should Colleen focus more on her direct reports' performance or organizational commitment? Will she exhibit different behaviors based on that choice? What are the advantages to focusing on one or the other?