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640 Corman held the opinion that although she has the "responsibility" for all her programs, she only has "authority" over some. She said that O'Grady does expect communication on everything although she doesn't "just hang around all the time" interfering. Unlike Zwahlen, who is on a friendship level with O'Grady as well as professional, Corman feels their relationship is more of a "boss to employee" one and very professional.
Reading throughout the monthly agenda notes, it is clear to see that O'Grady involves every staff member in these meetings. Everyone is able to discuss what they are currently working on or any announcements or concerns they might have. Not only are these discussed in a particular meeting, but the follow-up minutes are distributed to each staff person as well.
Both Zwahlen and Corman felt supported by O'Grady although Corman felt she needed to ask for actual physical support such as additional personnel help. O'Grady's encouragement, praise for staff, and time taken to listen, however, were cited by both managers.
Result 2 - Department Roles The main role of the overall department and the sub-areas within it all has to do with relationships. Each person interviewed used this word and it is used several times in the 1995 year end report. O'Grady said, "The focus of this department is around relationships with the community, physicians, patients and volunteers." She said the CPRD helps the hospital "deal with the inside and outside world" since they serve publics in both.
O'Grady said her department involves the community in helping make some decisions and other times they just let the community know what they are planning to do. She said there are situations that lend themselves to both methods. O'Grady said her department tries to make sure the public is aware of its free community service programs and know about the specialized care the hospital has just for children. A common theme they try to express is "one size doesn't fit all" meaning that children need to come to a children's hospital where equipment is the right size and the caregivers are specialized in pediatric issues and needs. O'Grady said the healthcare marketplace is "cut throat" right now and her department's goal is to do their best for less or "at least convince the payers and physicians - our market - that we are."
Zwahlen said the goal of the Pediatric Telecenter is to "develop relationships with all the community - patients, families and physicians." The Pediatric Telecenter houses five different programs: Physician Hotline, Admission and Discharge Notification Service, AfterHours Care and Call Triage Service, Parent Information and Referral Center (PIRC), and the Physician Referral Service. Each of these is designed for a different public. Some need marketing and publicity, whereas others do not. PIRC is a free community service that is publicized on bus cards, billboards, in newspaper and magazine ads, phone directories, and at educational fairs. It is the most highly publicized program in the Pediatric Telecenter although it is not considered a money making program. According to a CPRD Year-End Report, "PIRC plays a significant role in the promotion of the most appropriate use of health care resources." Pediatric nurses answering this toll free line respond to health questions for parents and other caregivers. The Physician Referral service is also for the community because it has over 400 affiliated doctors to which families can be referred. Zwahlen said the primary public for these programs are parents and caretakers and her role is "to get people aware of these services they can get for free."
The Physician Hotline and AfterHours Care and Call Triage Service are designed to appeal to the community physician so it is a set market that can use these services. Physicians can purchase these services, which provide nurses to triage after-hour calls and provide a clinic where the physicians' patients can be seen after hours. Both of these programs were started a few years ago and are continuing to grow. ZwaWen said they have not marketed the AfterHours 641 program to date, but it is included in the strategic plan of the department and should happen in the future.
The Patient Discharge Program is a completely different program whose public is the patients and their families. Zwahlen said nurses call patients after discharge to answer any further medical questions. Zwahlen said the patient satisfaction is a large focus right now and this program helps them measure what families think.
Most of Zwahlen's programs can be quantifiably recorded as verified by the researcher.
She has statistics, graphs and tables that show how many calls they have received, referrals to the hospital, number of emergency room visits they have preempted, etc. Zwahlen has the ability to take these numbers to show how greatly her programs impact the hospital financially.
Corman has a completely different role as the Community Outreach Manager. She is in charge of community education, educational outreach, hospital tours, SafeKids Coalition of San Mateo and Santa Clara Counties, and serves as a liaison between the hospital and other community organizations and the public. She sees her role as having the hospital out there in the professional community by being involved in coalitions, and committees. She said the "hospital needs to be seen as a player in community programming."
Corman said the hospital cannot exist unless patients come to it, but she does not feel she does actual "marketing" for the hospital. Corman said she does the "feel good" stuff and markets the hospital in a "more subtle and comfortable way." She also said this is not like other types of marketing because even if she convinces someone that LPCH is the best place for their child, there are other factors parents have to deal with such as HMO options.
She builds "relationships" with schools, organizations, businesses, physicians and the general public in her job. Corman said LPCH wants to be "collaborative" and they realize that "taking care of kids is a community effort - not just one or more programs." Her main public is the general community and more specifically, the parents. She said one of her roles is to "provide our experts as people available and specialized to talk with parents with needs." Parents are one of the main publics served by the CPRD and in the LPCh Report to The Community. It emphases this commitment by stating, "In a time when caring for children seems harder than ever, LPCH wants parents to know there is a place to turn for help." It is one of Corman's roles to make sure parents know about this help. Unlike Zwahlen, Corman said she "cannot measure our success accordingly because it is immeasurable." Corman can show the number of events attended, tours conducted and promotional supplies distributed, but there is not an accurate way to show the impact this area has on the hospital, and definitely not a way to show it financially.
Each of these areas has very different focuses, but they are all similar in that they build relationships, which is one of the goals listed in the year end report.
Result 3 - Dominant Coalition This was the one area where interviews and participant observation were the only two methods of evidence used. There is nothing in writing that would show O'Grady's unofficial role in the hospital's dominant coalition. However, each person interviewed, including O'Grady, agreed this was fact.
O'Grady said there are certain members of the senior management team that she is close to and feels she has "some impact" on decisions made. She said there are "certain ones of them that seek out my opinion on a regular basis" because they care what she has to say and they listen closely. O'Grady said she makes sure the right people hear her and that she will bring issues to senior management if she deems it necessary. However, she said she is "not emotional- I do it in a data-driven kind of way." O'Grady said she goes to these members with facts and clearly 642 explains why it is important to her and why it is important to the institution. She said, "It doesn't work if it's just how I feel about something."
Zwahlen and Corman were quick to say that O'Grady has a special role in this dominant coalition and that it has helped their department. Corman said O'Grady's role has a positive effect on what she does for Corman's department. She said O'Grady is "highly respected by senior management and those higher." Corman also said that if O'Grady is associated with something, that gives it more importance.
Zwahlen said O'Grady has "brought personal power to that role" that someone else would not have and she has "brought the department into the limelight." Zwahlen cited O'Grady's personal friendship with the hospital's chief operating officer as a "springboard" to this role of power and that O'Grady purposefully cultivates certain relationships that she knows will be helpful to her department. Zwahlen feels O'Grady's role has had a definite impact on her own department and she knows she reports to "a fairly powerful person." Zwahlen attributes much of O'Grady's focal role to the relationships she has built in the past 20 years, the ones she continues to build and her "great personal touch." Zwahlen also said what O'Grady does is "behind the scenes" so she words hard at building these relationships, but many people do not even realize her impact.
Results 4 - Nursing Background As stated previously in this case study, O'Grady is the director of a department that oversees medically-based and non-medically based programs that have various different markets to which to publicize. She works with the media, fundraising team and others, but her background is in nursing which has had an impact on her management style and feelings about the department. O'Grady said her nursing background has helped her "incredibly" in her new management role. The relationships she has built with nurses, physicians and management through the years has been useful in knowing who to talk to about getting things done and promoting various programs. She said her training as a nurse was also quite important because she was trained to always "assess situations" which she has carried over into this new role. As a nurse, O'Grady said she was trained to be outcome oriented. She also said that, "As a nurse you have a lot going on at once - juggling, reprioritizing, and attending to details all at the same time.
That preparation has helped me manage."
This nursing background helps O'Grady as she oversees several nurses who staff the Pediatric Telecenter and has helped her create the Community Education program, which is a monthly seminar on childhood issues available to parents. Corman said O'Grady's nursing background is evident in all she does and can be helpful when a new community outreach program needs support of the medical staff. This nursing background has personally affected Zwahlen. She worked with O'Grady when they were both nurses and later on, when Zwahlen was laid off, O'Grady helped her get a job at the Telecenter. O'Grady's nursing background has been brought out in many different ways in her current managerial role.
Results 5 - Effects of Healthcare Changes This is the only result that is an aberration because none of those interviewed said the same thing. Only one question was asked about the effects they expected from all of the changes in the overall healthcare system. However, this question had larger meaning because LPCH is about to merge with two other Bay Area hospitals, which means major changes are forthcoming.
Zwahlen felt that her area was pretty safe during this upcoming time of change. She said, "We are one of the minority departments that will be positively impacted." Zwahlen attributes this to the services she supervises and said they are at the "forefront" of needs and wants in the 643 healthcare community. She said they have been serving LPCH quite well and the hospitals considered in the merger do not have any such telephone services so it is a "good opportunity" for us to expand.
The Community Outreach Department is not so hopeful. Corman said this department has "not been on the highest priority of the External Affairs Department, much less the hospital." She said some of what she does exists in other departments and feels it is quite possible that her department could be eliminated.
O'Grady answered in the middle of this question. She said she really doesn't know what might happen - "the department could become very important or it could become superfluous."
She said everyone needs to "understand the culture that is coming" and that change is inevitable.
"Can we preserve what we've done?" she asked. "I sure hope so."
ConclusionsThe three research questions were answered in this study and the results corroborate earlier predictions. The management style of the Community and Physician Relations Department (CPRD), led by Terry O'Grady, definitely leans towards the participative theory, but will resort to the authoritative style on certain occasions, in a mixed motive manner.
Two-way symmetrical and two-way asymmetrical communications also are in evidence.
The roles of each department are quite different and impact different audiences. Some programs are designed with input from the community or based on community needs. Some decisions are just made by the hospital without such input. Therefore, the CPRD implements the asymmetrical and symmetrical forms of communication with their publics.
Finally, the role of O'Grady within the dominant coalition has been proven to have an impact on her personal role within the hospital and the importance of her department. Her department is looked at with more respect and she has the ear of those in the senior management.
She has an unofficial role in the dominant coalition of the hospital.
These findings are important to those in the healthcare profession and managers of any profession. Management style, communication behavior and working with the dominant coalition are important factors to be considered by any professionals can see how these three areas have an impact on a department going through change. Since many hospitals are going through similar change, they would be wise to read this case study and get ideas how they can make improvements or avoid certain mistakes before it affects them. This case study also will be useful to academics because it substantiates and modifies those theories by which managers communicate with their own staffs.