Critical Thinking Strategies in Decision-Making

¶ … administrative assistant to the CEO of Faith Hospital is to help the CEO map out a plan to deal with diverse pressures on the hospitals, which include falling revenue and a staff that makes life-and-death decisions based on personal ethics rather than established standards at the hospital. Chris's first assignment as AA to the CEO is to gather information for the CEO so the CEO can begin to lead all of the hospital staff to a solution of their problems.

KEY PROBLEMS/ISSUES

Faith Hospital has several problems, many or all of which are related to a lack of specific guidelines for staff to follow when more than one choice of plan appears to be the right one, depending on the person's personal ethics. The only written guidelines the hospital has is their mission statement, which is far too vague to serve as operational rules. With no operational rules in place, individuals within the hospital make varying decisions, even though those decisions can have profound legal or fiscal consequences for the hospital.

Fiscally, the hospital has some high fixed costs without a fixed income. Their income comes from patients, and patient numbers have dropped recently. The hospital has also had outside agencies attempting to influence hospital policy: Child Protective Services is looking at some of their medical pediatric practices. All of the issues raised in Chris's meeting with the CEO are related to ethical dilemmas, with each person or agency deciding independently what is the right and best action to take in a medical crisis.

ANALYSIS/EVALUATION

The decision-makers at Faith Hospital appear to look to their mission statement for answers, but the mission statement is too broad and all-encompassing to be applicable in individual patient decisions. Mission statements are not intended to act as a set of guidelines for day-to-day actions.

In addition, hospitals compete for customers just as any other business does. Even not-for-profit organizations have to have enough money to remain operational. Patients have a choice of where to go for medical care.

PLAN OF ACTION

The one great strength Faith Hospital has in this situation is a Board of Directors united behind their mission statement. While the mission statement is not the problem, it can be a starting point. Now they have to decide how the hospital will act when presented with medical crises.

The hospital must set specific goals and objectives that address both the hospital's mission and financial needs. They cannot fulfill their mission if they have to scale back services to the point that it affects patients negatively. Their goals and objectives must include strategies for drawing patients to Faith instead of some other hospital to make sure they do not encounter fiscal problems that would result from declining numbers of patients.

The goals and objectives will then have to be followed by specific plans of action. For instance, it will not be enough to set a goal to restore former patient levels to previous highs in one year or to increase patient levels by another 10% by the end of the following year. Such goals will have to be supported by specific plans designed to accomplish the goals and likely to do so.

Right now neither the new Administrative Assistant nor the CEO could write such goals. The hospital has employees with markedly diverse views on important questions, and clearly they are people with high ethical standards. If an abstract goal is simply dictated to them from hospital administration they will still feel compelled to act ethically, and since views on ethics vary, they will still have a hospital with a patchwork quilt of responses to standard hospital dilemmas.

The hospital's difficulties fall into several categories including legal, ethical, fiscal, human resources, and public relations. Chris should first talk individually and face-to-face with the heads of each of these departments. he/she should take his own list of questions, and in addition find out what the concerns of these individuals are. Chris should work hard to establish a positive and open relationship with these people, because he/she also needs to talk to the individuals who make legal, ethical and fiscal decisions at a more basic level as well. he/she does not want anyone in this process to think that he/she came into his new position to reduce staff, cut budgets, or to implement any other highly negative plan.

He/she should write memos to the participants summarizing their discussions in neutral or positive terms to make absolutely sure he/she understands the view of the people he/she interviewed. If possible, since Chris is so new to the position of Administrative Assistant to the CEO, he/she should deliver these summaries in person also. Since no real policy is in place regarding many of the current difficulties, the recipients of these memos might interpret them as rules to work by.

He/she should give Pat a broad overview of the problems, demonstrating that the departments have no clear focus, which is why individuals have to make ethical decisions based on personal standards. But since there are such a variety of views regarding how the hospital should function, the CEO will have to develop teams of people to look at the problems in each area. These teams should be vertical in design. For instance, the fiscal team should include the CFO, but also someone representing admitting clerks at whatever level insurance decisions are made. Whether, and how many, cases the hospital admits when the patient does not have health insurance affects both ethics and the financial well-being of the hospital.

Since there seems to be no clear overall plan, the first step should be for all department heads to meet with Chris and determine possible major goals for the hospital. These goals, which should be approved by the Board of Directors, would lay the framework for work within departments to set goals and objectives.

The CEO should organize these committees in every branch of hospital functioning. I is possible that there are additional problems stemming from a lack of clear focus regarding how to implement the hospital's mission statement that the CEO is not yet aware of yet. These committees need to have goals set for themselves, especially including a timeline, since the hospital needs solutions as soon as possible. People at all levels of hospital functioning should be included in the process in some way. This process will probably result in rules that not all will agree with, and it will be easier to get people's cooperation if they have been included in the process.