The surgery department at State Hospital, a major research and medical center, is experiencing some significant change. New senior leadership has recently been appointed and the culture of this clinical department is rapidly changing. The previous director of the surgery department was Dr. Joseph, who might be characterized as a laid-back and relaxed administrator and leader. Dr. Joseph was the director for just over 10 years and was very confident in his position. During his tenure, State Hospital did rather well. Not only did it have strong revenue from good paying patients, but investment revenue in combination with a successful foundation fundraising campaign further contributed to State Hospital's financial success. Dr. Joseph had a strong people-oriented leadership style and had positive relationships with all of his direct reports. He often empowered and developed other physicians, as well as the residents, nurses and operating room staff to manage their respective areas while he maintained a hands-off approach. Overall, he was well-liked, appreciated and he sometimes would socialize with department staff outside of work. Over the last year and a half, the poor economy with its negative downward trend has had an impact on State Hospital. The insurance mix has changed from a private payer base with some government program support to one highly dependent upon Medicare and Medicaid payers. It is believed that this is a result of changing community demographics to an older and, therefore, more government programfocused payers entering the hospital. The community has also experienced in increased unemployment rate surrounding State Hospital and many people who once had private insurance with their jobs are now on State-funded programs such as Medicaid. The net revenue as well as margins for all departments in the hospital has decreased, but especially in the surgery department. This may be due not only to the change in payer mix, but also because elective surgeries are being postponed because people are finding that they can't afford the procedure and put it off for later. Dr. Joseph has been receiving a lot of pressure from the vice president of medical operations to reduce the costs in the surgery department. Dr. Joseph did not feel that he could personally address this concern at this point in his career and he decided to retire in the face of these changes. His retirement happened much sooner than he expected. As a result, a new physician has taken over as the interim director. Dr. Green is somewhat younger and has impressed the vice president with the quality and efficiencies of her surgeries. She has some of the best outcome measures including on-time operations and infection rates and all of her peer feedback scores have been in the 90th percentile. She is very effective in working with the nurses and has built strong relationships with the surgical staff, in addition to working with the new surgical care infection initiative. She regularly attends surgery department meetings and volunteers to be on special ad hoc committees. Dr. Green is anxious to begin working on improving the surgery department outcomes. Even though she is acting in the role of an interim director, she is anxious to prove her capability as an administrator and make an immediate impact with the department. She has scheduled weekly meetings with the other medical director peers and surgical managers. She holds staff accountable to hospital policies and enforces rules that may have been ignored for many years, for example, the dress code and appropriate professional behavior. She has a strong visibility in the surgical department and makes daily rounds or scrubs in to observe certain procedures. Dr. Green strongly encourages accountability and she consistently holds her staff responsible for improved departmental outcomes and reduced costs. A few employees have already been cited for not following through on some policy changes. Dr. Green tries to stay current in healthcare management topics by reading journals in the field. Recently, she has read an article about transparency in clinical units and the impact that this has on financial outcomes. Impressed with this evidence, she begins posting performance dashboards, which may be embarrassing some of the lower performing doctors and clinical staff. There seems to be quite a bit of grumbling about the changes in the surgery department. Although the staff understand the need for the changes and a more engaged and active leader, they think that Dr. Green is micromanaging the department and there is a general lack of trust. They also believe that change is happening too fast. The faculty and staff have a concern about job security as well. Senior staff would like to approach Dr. Green to voice their concerns. However, there is some fear and hesitation from the junior staff and they prefer to remain silent and not voice their opinions. They are waiting to see how things progress in the department. Due to the differing concerns between senior and junior staff, there appears to be a rift developing between the groups because of how they want to address the issues with Dr. Green.

1. How do you characterize Dr. Green's leadership style? What are the strengths and challenges she faces as a leader?
2. Should the vice president of medical operations be involved? How or why?
3. Is this leadership style having an impact on morale? What recommendations do you have to improve the situation?
4. What style of leadership would you prefer to work with? Justify your response

2 academic and/or professional references.