Nursing Management

Transitioning to a New Leader Louis Rubino The Surgery Department at St. Gerard, a major academic medical center, is in the midst of change. New leadership has been appointed, which is rapidly changing the culture of the clinical area. The past Director was Dr. Marshall, who was a laid-back administrator/manager. He had been the Director for over 10 years and had become very comfortable in his position. Times were such that the academic medical center did very well. It could rely on not only strong revenue from good paying patients, but a steady stream of investment income, based on a successful fundraising campaign from a few years back. Dr. Marshall had a strong relationship-oriented leadership style and got along well with all his direct reports. He empowered the physicians, residents, nurses, and other operating room staff to manage their areas without much of his involvement. He was well-liked and oftentimes socialized with the Department personnel outside of work. The downward trend with the economy has taken its toll on St. Gerard. The insurance mix has changed from a private base with partial government program support to one highly dependent on government payers. The community demographics have changed to being older and, therefore, more Medicare patients have entered the facility. The unemployment rate surrounding St. Gerard has increased and many people who once had private insurance through their employers are now on state aid (Medicaid). The net revenue of all departments has decreased, especially in the Surgery Department, not only from the change in payer mix, but also because elective surgeries are being postponed. Dr. Marshall received a lot of pressure from the Vice President of Medical Affairs to decrease costs in the operating room. He did not feel up to the challenge at this point in his career and decided to retire earlier than he once expected. A new physician has been appointed as the Interim Director. Dr. Silver is a much younger surgeon who has impressed the VP with her efficient surgeries. She has the best on-time operations and all her peer scores are in the 90th percentile. She has been very effective working with the nurses on improving their Surgical Care Infection Prevention Scores (SCIP) and is active in the Surgery Department meetings, often volunteering to be on special subcommittees. Dr. Silver is anxious to turn things around. Even though she is only appointed as Interim Director, she wants to prove her abilities as an administrator and make some immediate changes in the Department. She has weekly meetings with her medical directors and managers. She is enforcing hospital rules that have been ignored for many years, like the dress code and appropriate professional behavior. She makes rounds daily and even scrubs up to observe what is happening during procedures. Dr. Silver believes in accountability and is holding her staff responsible for good performance and for reducing costs. A few employees have already been written up for not following through on policy changes. She tries to stay current by reading journals in the field and has read an article about the value of transparency in work units. Impressed with this best practice, she immediately begins posting productivity results, which embarrasses the poorer performing doctors and clinical staff. The Surgery Department faculty and staff are grumbling about all the changes taking place. Even though they seem to understand the necessity for all the changes and more active leadership, they feel Dr. Silver is micromanaging and does not trust them. They also believe that the changes are just happening too fast. The faculty and staff are concerned about their job security. The more senior associates want to approach Dr. Silver and let her know of their concerns. The more junior associates are afraid to be included in this meeting and would rather just stay silent and see how things progress. Now, these two groups of workers are beginning to form a division due to how they want to address these issues. Answer the following question using the information provided in the case study: What is your assessment of the different leadership styles displayed by Dr. Marshall versus Dr. Silver? How might Dr. Silver employ a more “emotionally intelligent” approach as the leader? What could Dr. Silver have done to make an easier transition for the employees and the organization after Dr. Marshall’s departure? Give specific examples to illustrate your points. How might you use this information as a Nurse Educator to be an “emotionally intelligent” an effective leader?
Show more