Would you explain these questions? I highly appreciate it!

Dr. Jamie Thompson

Dr. Elizabeth Clarke was in her office late one evening, reviewing overtime reports from the previous month. As chair of the surgery department at University Hospital, she was responsible for overseeing the entire team of surgeons, nurses, and staff of the different surgical divisions within the department and ensuring the smooth operation of the overall surgical service.

Overtime costs had been higher over the past several months, often as a result of extra cases added to the schedule by Dr. Jamie Thompson, one of the surgeons recently hired in the general surgery division. Dr. Clarke knew that the hospital budget office (not to mention the staff who had to stay late in the operating room) wouldn't be happy about the overtime, but she was also proud of the resultsboth in terms of volume as well as patient outcomes and satisfaction scoresthe department had been getting, and she couldn't help attributing some of those gains to the hiring of Thompson.

Dr. Clarke had been introduced to Jamie Thompson by one of her friends from her residency training, who now taught at a prestigious medical center and had mentored Thompson. Dr. Clarke was impressed during their interview: "Jamie seemed to have a lot of drive and gumption, which is what I was looking for in someone who could help grow our surgical services here at University Hospital. I felt that we had a lot incommon and shared a vision about how the department could expand and improve. We got along really well."

In the time since joining the department, Jamie Thompson had built a reputation as an excellent surgeon and was very popular with patients and their families. Dr. Clarke thought Thompson had the potential to become one of the best surgeons in the hospital: "It hasn't been that long, and already several senior people have commented on Jamie's surgical technique, and multiple patients have come to me and said 'Oh, we love Dr. Thompson!'"

However, these were not the only comments Dr. Clarke had received. On the way to achieving these great surgical results, Thompson often created chaos within the organization. "When a patient presents to clinic," Clarke noted, "Jamie will often try to push the envelope and add that case on top of the cases already booked, with little regard for how the schedule or workflow might be disrupted." As one of the hospital anesthesiologists recently complained, "Even on days when the schedule is totally full, Jamie will try to squeeze a 'quick little case' in there, and then that case inevitably takes longer than anticipated, so now everybody's schedule is delayed. We are stuck in there until the procedure is done and can't start our next scheduled case, so it throws off our entire coverage."

These delays escalated throughout the day, spilling over into subsequent cases and causing tension between different members of the perioperative team. For instance, the environmental services (ES) staff, who clean and turn over the operating room (OR) between cases, had come to Dr. Clarke because they felt that the nurses in charge of the ORs were taking out their frustration on the ES team for delays they couldn't control: "They want a clean room, don't they? It takes how long it takes to clean it. We can't magically make it go faster just because somebody else's case went long. I know the OR charge nurse is getting yelled at by the surgeon, but it's not fair for them to turn around and yell at us about it."

Dr. Clarke had also received several complaints from other surgeons in the department: "They're irritated that Jamie's add-ons are happening at the expense of their scheduled cases. There's always that competitive edge among surgeons, and if they feel their numbers are taking a hit, they'll come to me angry, saying 'How can you let this go on? Jamie is disrupting everything and needs to go!' It has definitely caused some tension." At the same time, a group of nurses and scrub technicians had raised concerns about Thompson's behavior in the OR: "Dr. Thompson likes using all this new complicated equipment, so we have to stock and prepare' all those things on top of the instruments everyone else uses. And once we set it all up, we aren't always as familiar with the new instruments, so sometimes we take longer getting something when we're asked, or we get the wrong one, and the whole time we're being told to 'hurry up!' and 'get it right!'"

These kinds of complaints reflected one of the more challenging aspects of Dr. Clarke's role as chair of surgerymanaging a department that employs people in a wide variety of different specialties and professions, each with their own norms and expectations: "I was trained as a pediatric surgeon, so I know that world really well. But now I am leading the chiefs and surgeons of divisions like vascular, transplant, and trauma surgery, not to mention all of the different nursing groups, scrub technicians, schedulers, supply managers, and everyone else. They all have their own expectations and views of the world, and I have to bridge those, especially when the department has to coordinate with others in the hospital, like anesthesia."

Clarke had been chosen for this challenging role as a result of her successful track record in various other management positions and because of her reputation as a hard-nosed, focused leader. Indeed, she had already made a number of major improvements to the department during her tenure as chair, and she had recently put forth an ambitious new plan for future growth, pushing for the department to lead the region in surgical volume and patient satisfaction within the next five years. The last thing she needed was for this Thompson issue to derail her plan.

The chief of the general surgery division had already met with Thompson several times about the complaints, but it seemed these conversations had little meaningful effect on the problem. Dr. Clarke decided that she would have to step in and address the issue personally, especially since it had been her friend's recommendation that originally led to Thompson's hiring. But she found it far from simple to decide how to handle the situation. She could certainly appreciate having someone with such strong motivation and drive in the department, and it was hard to overlook Jamie's volume and satisfied patients.

But patients didn't see the havoc that was wreaked to make these results happen. That havoc had caused Dr. Clarke a lot of headaches, and she couldn't afford the anger and frustration among her staff growing any further. As she closed the last overtime report, she realized thatone way or anothershe needed to do something, and soon.

1. Describe the bases of power held by Dr. Jamie Thompson. Describe the bases of power held by Dr. Elizabeth Clarke.
2. What activities and people have contributed to Jaime Thompson's power? What activities and people threaten his power?
3. Is there evidence of political behaviour in the case? If so, who is playing politics?
4. Does Jamie Thompson exhibit political skill?
5. What are the ethical ramifications of the events in the case?
6. What should Elizabeth Clarke do now? Consider influence tactics in framing your answer.