write a summary of the discussion responses

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the question is to write a summary of the discussion responses

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read the responses for each question and write a summary about the responses of other team members for that particular question

do not include the names of the team members

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Question 1: Do you think the merger would have been successful if the administrators and medical staff of the two hospitals had been active participants in the discussions? What are some possible ways for the merger to be successful? Response 1: I'm not sure if this merger would have ever been successful. The case study described how these two health systems were polar opposites. I'm not sure what was in that consultant's report to make them believe a merger was the best option, but I do think that more input was needed from administrative staff and overall, more communication was needed in general, if the merger were to ever have a chance of success. Because of the lack of input, the case shows how the more problems were created with the physicians and the hospitals' boards. The merger also should have been more clearly laid out in the beginning, with each hospital maintaining its own identity while becoming a part of RRVHS. Communication was needed to make sure this plan operated smoothly, and that clearly didn't occur. Response 2: Sam, great response and I agree with you in a lot of the areas you talked about in your response! I also do not think that this merger would work in any way what so ever. Neither of these two wanted the merger in the first place so they should of just left it at that. There were so many opportunities that were missed, that could have made the merger successful in one way or another in the beginning. Response 3: I do not think either of these two organizations wanted the merger from the beginning and should have been left alone. Where I think they could have done well is the medical school clinic. This would have been a completely new initiative that with equal management would have been successful since most private practice physicians were calling for privileges. This would have been a good way to test the waters and create more market share for both hospitals. For the merger to be successful, they needed to keep the administrative staff and involve the clinical staff in order to see the merger through and create a culture where both hospitals and agree and can work together. The case study did not say anything about creating anew mission and vision and values for the new organizations. This is the biggest downfall in bringing everyone together. Response 4: I have had a busy week and haven't been able to read the chapters until today, sorry I'm posting late. I also haven't read any of the other answers yet, so sorry if this seems like I'm duplicating what someone else said. It seems to me that there were plenty of opportunities to make this merger successful that were missed. Getting administrators and medical staff involved would have been a huge help. Other missed opportunities include identifying ways to eliminate duplication of services between the two hospitals. Move all of OB and Cardiology to one or the other hospitals. Eliminate duplication in support services. It sounds like the board made no effort to understand the difficulty they would have trying to mix two nursing staffs, one with a union contract, one without. It also sounds like the structure of the board was designed to fail, and the decision-makers on the board lacked basic business sense (fire all the administration and start with new people). I can't imagine the nightmare of trying to meld these two cultures. One strategy that may have been more successful would be for the two organizations to enter into a joint venture instead of merging. This would allow them to share services without having to try to live together, so to speak. Response 5: This case reminds me about when Blodget Hospital and Butterworth Hospital were both acquired by Spectrum Health and merged. Blodget was a small community hospital and Butterworth a larger metropolitan organization. It was no surprise that there were many difficulties when the two became part of the same organization. With this in mind, I do not think that had the medical staff and administrators been more actively involved it would have improved the outcome. The culture of each hospital was so very different, and I am not so sure that the two cultures would have blended well. I still work with nurses who worked for Blodget or Butterworth before the merger and they still have a negative perspective about the merger. Response 6: Amy, it's interesting that there are people at Spectrum who still resent the merger. Without ever having worked for either organization I wondered how it was perceived by staff members. I think in the long run it was very beneficial for the community. I hadn't really considered the ethical issues involved in a merger before. Reading the case study, and especially the reflection afterward really highlighted some of the things that could be ethical problems. Maybe the formation of Spectrum Health was successful because there was more attention paid to things that were ignored in the case study? Transparency at the corporate board level especially, because in the case study they essentially blindfolded the individual hospitals to financial information. Also, they duplicated services, which wastes money. I see how that can be an unethical act, because the fictional board was squandering money that could have been used for patient care. I remember hearing that Spectrum eliminated duplicative departments at the different hospitals to improve efficiency. There are two other ethical questions about Spectrum. First, it has bought up many rural hospitals like Greenville, Reed City, Zeeland, Ludington, etc. Second, Spectrum owns Priority Health, a major insurance plan in this area. So the questions are first, whether they have created a monopoly with their local network, and second, how can the same corporation be both the insurer and the provider and remain ethical to the patient? Response 7: Those two questions at the end are great! I think they have the majority share in West Michigan, but with U of M purchasing metro and expanding quite a bit I think we will see some change for spectrum in the coming years. The only thing I can think of with priority is the patients don't have to purchase priority heath insurance, and the hospital still accepts all other forms, and at the corporate level, they own two different companies and its all kept separate. Response 8: Dave, I really liked your two ethical questions that you asked at the end of your response! It really made for us to open our perspective and way of thinking to a whole new light. Specifically, your last question about Spectrum being both the provider and insurer really gets me thinking how is it even possible, like you stated, for them to be ethical to the patient when they are on both sides of the patient care cases and issues. Response 9: Dave, I honestly did not know that Spectrum Health owns Priority health. This does bring up many ethical questions! You mention also that the difference between the SH merger and Richland Valley may be transparency. I definitely think that being transparent with the staff is important, but I also think that there is a sensitivity with this too. I think about all of those who may not want a merger and by sharing all of the details it may only make some employees angry and interested in creating conflict regarding a merger. Question 2: What are your opinions on Jack’s role as Chief information officer? Do you think he is the perfect fit for this position? Do you think Jack has made a right decision in giving Les a managerial role instead of an advisor? Response 1: I don't know if I would consider Jack to be a perfect fit for the position, but I definitely think he was a good fit and would've done better with more guidance from the CEO. The CEO seemed to just hire Jack and let him loose on whatever projects or spending he desired. In my opinion, the CEO should have realized that, even though as an IT expert, Jack had no healthcare IT experience, and healthcare is a much different industry than any other. The CEO should have discussed the implications of not keeping the medical staff in the know of what was changing, or that the major overhaul should have just begun in small steps with the CPOE upgrade. Jack's intentions were good, but his implementation was misguided. It seems like the hiring Les was a mistake, and that Jack could have benefited from the CEO's guidance with this issue as well. They could have discussed the option of using Heartland IT staff, and why that may have been better for the staff morale and expenses. Response 2: Sam, I agree with the fact that Jack was an experienced and enthusiastic about the position and needed some more guidance from the CEO. However, I think that Les would have been a good fit as a consultant for the organization. I think his role got out of hand because Jack was overwhelmed. When Richard was completing the hiring process the culture and patient values of the organization should have been at the forefront of the decisions making. I also think that Richard felt he had to back Jack over the nursing director because of all the money invested. Overall the implementation should have more thought out and organized from the beginning. Response 3: Thanks for pointing out how the CEO was part of the problem, Sam. I agree with you that he allowed Jack to a very long leash. In addition, he could have questioned the proposed increase in the cost of the contract a little more. Maybe that should have gone to the CFO or even the board for more review? It's interesting to me to read a case study in business ethics, because I'm used to seeing things from a medical standpoint. As I read this case study I initially only saw mistakes, not potential ethical lapses. The discussion in the chapter and in these questions has helped me understand business ethics a lot better. Response 4: Dave, I also think it is interesting to see this case from a business perspective instead of a healthcare standpoint. I just finished the module 10 homework on corporate compliance and thought about this case study. I wonder if this case were a real life scenario if a corporate compliance protocol if it would have gotten to the point it did. Specifically, would concerns over Jack have been brought to management's attention sooner? Response 5: When I read that Jack was expected to implement computerized physician order entry while having no health care experience, I cringed a little. In my opinion, being a CIO requires some clinical background. My thought was that the physicians were going to revolt, but as the case study explained, it was more widespread than that. As far as his role, I'd be willing to give him the benefit of the doubt on the decision to change vendors. However, the way he handled hiring the consultant and then favored him over his own staff looks like a real weakness as a manager. I would not want to work for someone like this. Response 6: Dave, I completely agree with you when you talked about the fact that he wanted to implement computerized physician order entry while having no health care experience was absolutely crazy to even think of happening!! I think like you stated it would be a goof idea on his side of things for him to change vendors for the benefit of the doubt. Overall, again like you said, I would also not want to work for someone like Jack as my boss or manager. Response 7: I have concerns over Jack’s role as the Chief Information Officer. My major concern is that because his background is not in healthcare I worry that his priority is not patient experiences and staff satisfaction. Healthcare is such a unique field and it is difficult to enter and be successful if you do not a foundation. That being said, though, I also think it is beneficial to have a fresh perspective. We often get caught up in doing things the same way simply because it is what we know. Jack brings a fresh perspective and this does have the potential to be a large benefit to Heartland. It would be important, therefore, that Jack receive appropriate healthcare training from Hartland and this is not mentioned in the case study. Response 8: I think the training and carryover of the mission and patient-centered care are the two most important parts he was missing and could have been solved by bringing everyone together when there was an issue instead of what happed in the case and everyone was kept separate. Response 9: Jessica, I agree with you when you stated that the training and carryover of the mission and patient-centered care are the two most important parts that were missing in this issue. I also think that they could have solved the overall issue in this case if they would have brought along and implemented these two things that you had suggested in your post above to solve a lot of the issues. Question 3: Can you remember a time when you were faced with a dilemma or have seen people facing a dilemma because they knew somebody was bending the rules and they wanted to report them, but they knew that their own career would suffer by doing so? Discuss your conflicting moral demands at your workplace. Response 1: Great question Divya! I have experienced this in a few different situations, but they were all when I was an intern. One that stands out in my head was, from a health care facility, this lady I was shadowing for the day that my boss had placed me with was not doing her job what so ever. She was saying that she was going to patient rooms for Medicaid applications and marking them off, but she really wasn't. She also was going into patient charts she shouldn't have been like other family members to check results. At the end of the day when I met back with my boss and talked over my experience I couldn't not not say anything about it, and they ended up closely monitoring this lady! I found it hard for myself to speak up being I was just an intern at the time, but at the end of the day I new it was the right thing to do and a lot of patients were loosing out on much needed help. Response 2: That's great that you spoke up Abby! I know that when I was in an intern status if felt it difficult to say anything or even ask questions about things that I didn't think were correct or "following the rules" How was your received by the leadership by the organization? Response 3: My boss who I reported it to was actually very open about talking about it and was thankful I said something. I think it made her also look at me in a different way almost in a higher level of respect in a way if that makes sense. I know as an intern it is easy to be looked down upon and in ways seen as not valuable because you are not going to be at that organization for long. Response 4: I personally haven't experienced or known anyone with this type of dilemma, especially one as severe as the described in this case study. These types of dilemmas are definitely difficult, and in this case, it seems like Jim has a high likelihood of losing his job if he reports what's occurring on the board. If I were to ever be in his situation, I think the best plan of action would be to begin the search for a new job while allowing whatever is currently happening to transpire. If your career would suffer because of reporting, it's a sign that the culture of the workplace does not have high moral or ethical standards, and chooses the easy path over the right path. Response 5: A long time ago I worked with a physician who was unethical. I'm not able to share examples here. I was in a leadership role at the time. Along with another leader, I began collecting and saving documentation that showed his unethical practice patterns. It wasn't hard, he made no effort to cover his tracks. This was after he had been reported and investigated for questionable billing practices previously. (We were looking at other behaviors, not billing issues). I think he felt that he could do whatever he wanted because of the previous investigation. After several months, we notified our corporate integrity officer. As I laid out the documentation and presented our evidence, his first comment was, "Oh, he has to go." That made me feel confident that we were going to impact the situation. There were multiple meetings with Vice Presidents, Corporate Integrity, the other leader and myself, and this physician. In the end, nothing happened to the physician, even though I had a stack of documentation almost two inches thick. I wouldn't say my career suffered, but I'm no longer at that organization. Response 6: Wow Dave, I'm not sure how I would have reacted to nothing happening to this individual after all the meetings and evidence. Was this someone with a high reputation? or were they at the organization for a significant amount of time that impacted the punishment procedures? Response 7: I have been in this type of a situation in a way. I was recently told by a co-worker that another faculty member (whom I do not know) is not providing adequate learning experiences for their students. Apparently this person says she is sick very often and just does not shown up when she is supposed to teach her clinical experiences. The students have complained, but because there is an instructor shortage this person still has her job. The co-worker who shared this with me does not feel that she should have to complain because the students already have and nothing was done. It is important to me that the students have successful experiences, but because I do not even know this person I also do not feel comfortable addressing it with management. I did tell the coworker who told me to encourage the students to continue to report their concerns. Response 8: Amy, that's a really tough position to be in. I'm not sure how I would have acted in that situation. I know I would have done the same as you, encourage continued reporting. I'm not sure if I would have reported the issue. I think part of the reason I'm not sure is that an organizational culture is a powerful influence on our actions in a given situation. It's easy to sit outside the situation and say you'd do one thing or another, but completely different when you're in the "office politics" of the situation. Another reason is that sometimes things like this happen and we don't realize we're faced with an ethical dilemma until after the fact. Then it may be the wrong time or too late to act. Response 9: I agree David, I do not think I even realized what an ethical dilemma I myself was in until being faced with this question. Another problem I have with reporting it myself if that I did not witness these actions myself, nor was I given the information from the students myself. Therefore it is only hearsay to me at this point. It is a very difficult position to be in.
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Running Head: DISCUSSION RESPONSES SUMMARY

Discussion Reponses Summary
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DISCUSSION RESPONSES SUMMARY

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Question 1
There are many doubts as to the possibility of the merger being successful. As the
case study describes the two health systems, they are quite distinct and thus a merger may not
have been the best option. Also, there was more need for more input from administrative and
medical staff as well as more communication if the merger was to be a success. The mergers
should also have been clearly laid out from the word go, with the two hospitals joining the
RRVHS. However, it is clear that none of the two facilities was for the mergers idea, but the
medical school clinic would have done well, and many opportunities that could have aided
the merger’s success were missed from the beginning. Moreover, in the case study the plans
of creating a new vision, mission or values were not mentioned anywhere besides this being
essential for harmonizing the two hospitals. Also, more of the missed opportunities in the
merger include the elimination of means of avoiding services duplication. This could be done
by avoiding similar performance services such as OB, cardiology and support services.
Further, the board, which seems to be short of basic business sense, ignored the
complexity of combining the two distinct nursing staffs, one with a union contract and
an...


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