Answers the case study questions

Hello,read chapter 6 , then answer questions case with your understanding please write the question withe the answers in a word documents. Make sure that the answer for each question no more than three to four sentences and please do not use hard vocabulary use simple words .make sure to submit it on time thanks


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Case Study
Leadership for Health Professionals: Theory, Skills, and Applications
Third Edition
Gerald R. Ledlow
A major horsing event was scheduled to occur in the city where my medical center was located. A royal princess from Great
Britain had planned not only to attend this horse-jumping contest, but also to actively participate in the contest. I had a visit
from Scotland Yard to advise us that the royal princess was planning to be at this event for 3 days. They requested that we
reserve an entire wing of the medical center in case she fell from the horse and injured herself.
At this time period, most hospitals were almost entirely occupied every day, and my medical center was generally 96–100%
full. Scotland Yard insisted they were willing to pay in order to reserve an entire wing. I asked them if they realized how much
it would cost to reserve a wing in a major medical center, and they said they did not care. In fact, the cost was several million
dollars for 3 days. However, because of our volume and our role as a tertiary center, it was almost impossible for us to keep an
entire wing unoccupied for 3 days. We felt it was not in the best interest of the communities for which we were responsible. We
did tell Scotland Yard that we would lease at least half a wing (approximately 20 beds) to them for the 3 days, and we would
assist them in setting up communication centers, information centers, and an area for the family.
Content Link:
Ledlow & Stephens, Leadership for Health Professionals: Theory, Skills, and Applications, 3rd Edition, Jones & Bartlett Learning,
Chapter 6: Planning and Decision Making
Copyright © 2018 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
2 ? Case Study
B4. Case Study Questions
1. Describe how you as the executive of this medical center would have handled the request from Scotland Yard. Would
you have done anything differently? Explain your answer.
2. Identify the key problems of allowing an entire patient wing of a busy medical center to be reserved rather than serving the community.
3. Would you have refused this request entirely? And would that have created an international incident?
Copyright © 2018 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Chapter 6
Competence II:
Application of
Skills, Tools, and
“Thinking always ahead, thinking always of
trying to do more, brings a state of mind in
which nothing seems impossible.”
Henry Ford
Learning Objectives
• Describe planning, decision making, and training
in health organizations and provide examples of
• Summarize the planning process and the decisionmaking process within the context of leadership.
• Apply and relate at least two different decisionmaking models to a leadership situation.
• Differentiate the levels or components of the
planning process and distinguish each level or
component from the others.
Learning Objectives, cont.
• Plan and design a quality improvement
program based on a system of rational decision
making for a health organization.
• Compare and contrast willful choice to
garbage can models of decision making,
training leaders to training staff, and cultural
competence to ethics and morality.
• Planning is an essential leadership skill that
requires knowledge about planning and the
ability to structure and develop a system of
• Health leaders who can understand, apply, and
evaluate planning will have advantages over
those who haphazardly plan or fail to plan.
Planning, cont.
• Planning occurs formally, informally,
strategically (how the organization can best
serve its purpose in the external environment),
and operationally (how can the internal
capabilities and resources of an organization
be used effectively, efficiently, and
efficaciously to achieve the strategies and
goals of the organization as documented in the
strategic plan).
Planning, cont.
• Planning is a process that uses macro- and
micro-environmental factors and internal
information to engage stakeholders to create a
framework, template, and outline for section,
branch, or organizational success; planning can
be strategic, operational, or a combination of
Strategic Planning
• Strategic planning is concerned with finding
the best future for your organization and
determining how the organization will evolve
to realize that future.
– It is a stream of organizational decisions focused in
a specific direction based on organizational values,
strategies, and goals.
– The focus is on external considerations and how
the organization can best serve the external
markets’ expectations, demands, and needs.
Operational Planning
• Operational planning is about finding the best
methods, systems, and processes to accomplish
the mission/purpose, strategies, goals, and
objectives of the organization in the most
effective, efficient, and efficacious way
– The focus in operational planning concerns more
internal resources, systems, processes, methods,
and considerations.
Planning, cont.
• Planning is a journey. The journey must have a
destination; this journey must be planned. It is a
planned journey forward in time. In that light,
planning includes both a process (achieving goals
and objectives) and an outcome (the plan).
• The ultimate outcome of planning is a vision that
is achieved.
– The desired future state is the vision of the
organization. The vision is what the combined staff of
the organization strives to achieve.
Planning, cont.
• The strategic plan is a roadmap, the
organizational vision is the final destination,
describing where the organization is going.
• The healthcare leader must energize followers
to buy in to the vision in order for the
organization to begin its strategic journey.
– Vision must be tested and retested to ensure buy-in
from all stakeholders, including external and
Situational Assessment and
Environmental Scanning
• Situational assessment and continuous
environmental scanning are crucial for
organizations to survive in the dynamic health
• A health organization must understand the
impact of the operating environment. The
leader’s responsibility is to remain current and
recognize situational and environmental
changes that can impact the organization.
Situational Assessment and
Environmental Scanning, cont.
• Forces that contribute to the health industry’s
rapid and dynamic environment are varied but
are cumulative and thus, have a cumulative
impact on the industry.
Macro-Environmental Forces
• Legal (regulatory, executive orders, case law, etc.)
and ethical forces
• Political (including government policy) forces
• Cultural and sociological (including values
[beliefs and attitudes]) forces
• Public expectations (including community,
interest groups, and media)
• Economic forces
• Ecological forces
Healthcare Environmental Forces [also
called Micro-Environmental Forces]
• Planning and public policy (regulation, licensure, and
accreditation) forces
• Competitive forces
• Healthcare financing (third-party payers, public and private,
and financial risk)
• Technology (equipment, material, and supply entities) forces
• Health research and education
• Health status & health promotion (wellness and disease)
• [Integration with other health disciplines] Public health
(sanitation, environmental protection, etc.) forces
Rand Corporation
• The Rand Corporation suggests that the
immense pressure of cost-containment efforts
and speed of change are the leading factors
influencing the health industry at this time.
Multiple forces cumulatively contribute to
change in the health industry.
– Brook, R. H. (1998). Retrieved from on
May 11, 2009.
Application of Skills, Tools, & Abilities
• The dynamic whirlwind, often called “white
water change,” frames a picture of the world
the health leader must navigate.
• Health leaders must continue to use the
dynamic nature of the industry to challenge
their organizations, groups, teams, and
individuals to become more efficient, effective,
and efficacious while under significant costcontainment pressure.
• Kotter suggests eight steps to transform
organizations in dynamic situations:
1. Establish a sense of urgency by examining market
and competitive realities and identifying and
discussing crises, potential crises, or major
2. Form a powerful guiding coalition by assembling
a group with enough power to lead the change
effect [from any level of the organization] and
encourage the group to work together as a team.
Kotter, cont.
3. Create a vision to help direct the change effort
and develop strategies for achieving that vision.
4. Communicate the vision by using every vehicle
possible to communicate the new vision and
strategies and by teaching new behaviors by the
example of the guiding coalition [at lower levels of
the organization, the leader translates the senior
leadership’s vision for his or her section, branch, or
unit into understandable and actionable tasks for
that level and situation].
Kotter, cont.
5. Empower others to act on the vision by getting
rid of obstacles to change, changing systems or
structures that seriously undermine the vision, and
encouraging risk taking and nontraditional ideas,
activities, and actions.
6. Plan for and create short-term wins by planning
for visible performance improvements, creating
those improvements, and recognizing and
rewarding employees involved in improvements.
Kotter, cont.
7. Consolidate improvements and producing still
more change by using increased credibility to
change systems, structures, and policies that don’t
fit the vision; hiring, promoting, and developing
employees who can implement the vision; and
reinvigorating the process with new projects,
themes, and change agents.
Kotter, cont.
8. Institutionalize new approaches by articulating
the connections between the new behaviors and
corporate [organizational] success and developing
the means to ensure leadership development and
Changes in Environment
• Leaders of health organizations should consider the
changes in the macro- and micro-environment against
the cost, quality, and access constructs for the
community members they serve.
– Also need to understand changes to the health
organization concerning:
Supply chain
Revenue management/reimbursement
Community health status
The Leader’s Role in Planning
• People look for leaders who have a vision and
someone who can direct them in the path of the
• Planning is the fundamental function of
leadership from which all other outcomes are
• The first step in planning is establishing the
organizational situational assessment; then the
vision, mission, strategies, goals, objectives, and
action steps are developed.
The Leader’s Role in Planning, cont.
• The vision provides the motivational guidance for the
organization, and typically is defined and promoted
by senior leadership.
• Vision is how the organization intends to achieve its
goals while “mission” defines why the organization
pursues the goals it does.
• Both vision and mission are “directional strategies.”
• The mission statement is the organization’s reason
for being, its purpose.
• From the mission, strategies to achieve the
mission and ultimately, the vision, are devised.
• Goals are broad statements of direction that
come from strategies. This multilevel approach
focuses and narrows effort for each section
within the health organization.
– Goals further refine the strategies focused on the
mission. They are expected to be general,
observable, challenging, and untimed. Goals are
general in nature; objectives are highly specific.
• Objectives, in pursuit of achieving goals, are very
– SMART objectives must be “specific, measurable,
attainable, rewarding, and timed.”
• Action steps or tactics represent a fifth level of
planning and provide the most specific approach for
describing who, what, when, where, and how
activities will take place to accomplish an objective.
Health Leaders
• Planning can be described as an ongoing process
of thinking and implementing at multiple levels.
• At each level, health leaders are directing,
staffing, organizing, and controlling.
• Health leaders must remember that “what is
measured gets done”; all planning objectives and
action steps must be measurable, assigned to an
accountable and responsible person, and be set
within a time period.
Health Leaders, cont.
• Periodic progress reviews, monthly or quarterly, are
essential to see the movement toward success.
– In this effort of directing, staffing, organization,
and controlling, rewarding is also important. The
five elements are crucial as leaders embrace the
foundations and functions of planning.
– Health leaders must publicly praise success and
reward those who have achieved predetermined
action steps, objectives, and goals.
Decision Making and Decision Alignment
• Decision making occurs in all organizations.
Health organizations are faced with many
decisions each day.
• The decision-making process begins with
identifying a question, problem, an area needing
improvement, or an operational issue.
• Problems, issues, questions, and operational
challenges come to leaders and managers from
many different people, both within and outside
the health organization.
Decision Making and
Decision Alignment, cont.
• Leaders and managers usually are taught to utilize
the rational decision-making model using
analytical (quantitative) methods and when
necessary, coupled with group methods
(qualitative) such as normative group technique
(brainstorming, alternative categorization,
prioritizing alternatives, and selecting an
alternative based on group consensus) to
triangulate (using both quantitative and qualitative
methods) results and identify an effective
Decision Making and
Decision Alignment, cont.
• In truth, decision making is not as sterile and
ordered as most have been taught.
• Willful choice or rational decision-making models
together with reality-based, or “garbage can,”
models are used in organizations along with a
myriad of tools and techniques.
• The major domains of decision making are:
– Willful choice or rational models
– Reality-based or garbage can models
– Combinations of willful choice and reality-based
Methods of Decision Making
• Quantitative methods: Use tools such as multiple
attribute value, probability-based decision trees,
analytical mathematical models, linear programming,
and similar tools.
• Qualitative methods: Use tools such as focus groups,
interviews (formal and informal), normative group
techniques, and similar tools.
• Triangulation methods: Combine quantitative and
qualitative methods where, classically, qualitative
methods are “theory building” and quantitative methods
are “theory testing, validating, or confirming.”
Decision Making
• Bounded rationality in decision making
– Decision making must occur within the bounded
rationality of the environmental context in which
the problem must be solved.
• Willful choice decision-making models
– Decision-making models and current
understanding imply that decisions are made by
rational, intentional, and willful choice.
Willful Choice Decision-Making Models
• Choice is guided by four basic principles:
1. Unambiguous (you know what questions to ask)
knowledge of alternatives
2. Probability and knowledge of consequences
3. A rational and consistent priority system for
alternative ordering
4. Heuristics or decision rules to choose an
Willful Choice Decision-Making
Models, cont.
• Six-step model of decision making applies
willful choice model as follows:
Identify the problem.
Collect data.
List all possible solutions.
Test possible solutions.
Select the best course of action.
Implement the solution based on the decision
Willful Choice Decision-Making
Models, cont.
• The practical six-step model assumes time and
information are abundant, energy is available,
and goal congruence of participants (everyone
is focused on the same set of goals) has been
Criticism of Willful Choice Models
• Well-known leadership and management concepts
consider preplanning (short- and long-term) as the
method to solve ambiguity (not knowing what to
do) in business, but as task complexity increases
and time availability decreases, the ability to plan
and problem solve increasingly becomes more
• The rapid pace of operations and change in health
today make traditionally based organizations less
adaptive and flexible in complex environments.
Criticism of Willful Choice Models, cont.
• Information and time are assumed to be
abundant and relatively free resources in
rational and willful choice models; additionally,
organizational participants in the decisionmaking process are assumed to have similar (if
not the same) goals.
• These issues are the basis of willful choice
model criticisms.
Criticism of Willful Choice Models, cont.
• Reality of healthcare industry suggests that
preferences of participants in the decisionmaking process often vary in illogical and
emotionally dependent ways. Although
considered in the willful choice models, time
and information are not considered as valuable
or scarce as reality actually suggests.
Reality-Based Decision Making:
Overview of the Garbage Can Model
• Reality-based models, such as the garbage can
model, are intended to extend the
understanding of organizational decision
making by emphasizing a temporal context
(the situation at one point in time) and
accepting chaos as reality.
• Rational (willful choice) decision-making
models are a subset of reality-based models.
Reality-Based Decision Making: Overview
of the Garbage Can Model, cont.
• In ambiguous (do not know what to ask or do)
situations where time and information are
limited or constrained and “perfect information”
impossible to acquire, where organization
structure/hierarchy is loosely coupled, and
organized anarchy (chaos) seems to embody the
organizational persona, analytical decisionmaking models do not fit reality.
Garbage Can Model Concepts
• Garbage can models are attempts at finding
logic and order in the midst of decisionmaking chaos.
– Garbage, defined as sets of problems, solutions,
energy, and participants, is dumped into a can as it
is produced (streams of “garbage” in time); when
the can is full, a decision is made and removed
from the scenario.
Garbage Can Model Concepts, cont.
• Many things seem to be happening at once,
technologies are changing and poorly
understood; alliances, preferences, and
perceptions are changing; solutions,
opportunities, ideas, people, and outcomes are
mixed together in ways that make
interpretation uncertain and leave connections
Decision Making
• In management arenas, decision-making load, speed
required in decision making, uncertainty, and
equivocality (also known as ambiguity: not knowing
what questions to ask or what to do) are commonplace.
• The temporal nature of decision-making processes, if
taken as “snapshots” in time, would show sequential
arrival of problems, solutions, and information in a
complex mix of participants, environmental factors, and
consequences of prior decisions as reality in the
“organized chaos” of decision making in organizations.
Loose Coupling
• Since time is not static and multidimensionality is reality, the garbage can model depicts
the chaotic nature of decision making.
• Loose coupling in organizations fosters a
garba …
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