Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide
1
Managing Health Care Professionals
CASE FOR CHAPTER 11
By Sharon B. Buchbinder and Dale Buchbinder
Summary
In each of the scenarios below, put yourself into the crisis scenario as the Healthcare
Administrator who manages the Human Resource aspect of the facility.
Each of these scenarios is a real-world event that has been fictionalized for the text. You may
experience any one of these and many more situations in your first job and you need to be
prepared for the unexpected.
Choose three of the scenarios to use in your assignment. Submit your written response to the
scenarios you chose below based on factual data, not personal opinion, as the solution will likely
be linked to a health law and/or health ethic. You want to avoid expensive litigation and the
damage that unwanted behavior will have in the public perception of your practice.
You are welcome to utilized the resources at the bottom of the page, and/or include scholarly
resources of your own. A minimum of 3 scholarly sources is expected in APA format.
Answer the following objectives for each scenario,
Summary of case: This should include not only what was in the case, but additional
research you conduct on the outcomes of the case. What happened? Who was found
Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide
2
responsible? What were the legal ramifications?
Analysis and assessment: What are the quality-control problems in this case? This
will come from whichever quality assessment technique you chose.
Performance improvement plan (PIP): This is where you say what SHOULD be
done to prevent this error from occurring again, based on your analysis.
Methods to incorporate or overcome local, contemporary, and corporate
cultures: List and describe a few (no more than five [5]) validated approaches to
accomplish this.
Identify and overcome other barriers to implementation success: Aside from
culture, what else could be a barrier? Education? Training? Lack of resources,
including money?
Develop a maintenance plan: What will you do to be sure the organization never
forgets? Will you require onboarding orientation that addresses this issue? Will you
require annual refresher courses for current employees?
Develop an assessment plan: What METRICS will you use to evaluate the effects of
the PIP? How will you know when you have accomplished what you set out to do?
Scenario 1
You are a new administrator at Jonestown Medical Center. You receive a telephone call from the
nurse manager of the emergency room. Dr. Smith, an emergency room physician who is an
employee of your hospital, has just reported for duty. The nurse manager suspects that Dr. Smith
is intoxicated. What do you do?
Scenario 2
You are the CEO of Sleepy Hollow Retirement Community and Nursing Center. A resident’s
Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide
3
family has come to you to complain that their loved one, who is on pain medication, is in
intolerable pain. Her medications appear not to be working anymore. One of the family members
states, “My 90-year-old mother saw the nurse put the pain medicine in her pocket.” What do you
do?
Scenario 3
You are the practice manager of Docs R Us, Ltd., a large multispecialty medical practice
employing more than 100 physicians. You are conducting a random review of billing for doctors
in the practice and you discover that one of the internists in your group who treats mostly
Medicare recipients has been checking off the wrong code for her procedures on the billing form.
The procedures on the patient record do not match the billing form codes. You pull up her files
from the past 3 months and find a pattern of up-coding. When you meet with her to review this
miscoding, she becomes very defensive and angry. What do you do? How could you have
prepared better for the meeting with the physician?
Scenario 4
You are the assistant director of the hospital medical staff office at the Rural Outreach
Community Hospital in a tiny town in Arkansas. It is your job to verify physician credentials for
staff privileges. Your hospital receives an application from a physician for staff privileges. On
his application, it states that he graduated from medical school in El Salvador. When you call to
verify this, you are told that the medical school burned down two years ago and all the records
were destroyed. What do you do?
Scenario 5
You are a new administrator at a hospital, well-known for pulmonary medicine. The physicians
in the Intensive Care Unit (ICU), the Emergency Room (ER), and the department of pulmonary
Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide
4
medicine have demanded to meet with you about the shortage of respiratory therapists. You stall
them for 48 hours so you can gather data. What types of information will you need to collect to
have an intelligent conversation with this powerful group of physicians?
Scenario 6
Dr. White ordered an unusual dose of a medication. May Patterson, RN, sees the order and
believes it to be the wrong dose. She calls Dr. White, who insists that she give the medication—
as written. Nurse Patterson calls you, the administrator on call for the weekend, to resolve this
Resources
American Medical Association (AMA). (1992). Opinion 9.031 – Reporting impaired,
incompetent, or unethical colleagues. Retrieved from https://www.ama-
assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9031.page?
Brady, S., & Keene, S. (2008). Respiratory therapists can facilitate positive change with
institutional support. The Internet Journal of Health Administration, 6 (1), 1–5.
Bureau of Labor Statistics (BLS). (2014). Respiratory therapists. Occupational outlook
handbook, 2014–15 edition. Retrieved from http://www.bls.gov/ooh/healthcare/respiratory-
therapists.htm
Centers for Disease Control and Prevention. (n.d.). Risks of healthcare-associated infections
from drug diversion. Retrieved from http://www.cdc.gov/injectionsafety/drugdiversion/
Eiler, M. A. (2006). Helping doctors help patients for 100 years: Happy birthday AMA physician
masterfile. AMA Physician Credentialing Solutions, 9 (2).
Geruso, M., & Layton, T. Upcoding: Evidence from Medicare on squishy risk adjustment.
National Bureau of Economic Research (NBER) Working Paper No. 21222. Retrieved from
http://www.nber.org/papers/w21222
Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide
5
Government Accounting Office (GAO). (2010, January). VA health care: Improved oversight
and compliance needed for physician credentialing and privileging processes. Report
number GAO-10-26. Washington, DC: Author. Retrieved from
http://www.gao.gov/new.items/d1026.pdf
InformationWeek Healthcare. (2014, Jan 13). Feds must prioritize EHR billing fraud, watchdogs
say. Retrieved from http://www.informationweek.com/healthcare/electronic-health-records/feds-
must-prioritize-ehr-billing-fraud-watchdogs-say/d/d-id/1113403
Mallow, Peter J., Pandya, Bhavik, Horblyuk, Ruslan, Kaplan, Harold S. (2013) Prevalence and
cost of hospital medical errors in the general and elderly United States populations. Journal
of Medical Economics 16, 1367-1378
Mossman, D. (2011, September). Physician impairment: When should you report? Current
Psychiatry, 10 (9). Retrieved from http://www.currentpsychiatry.com/home/article/physician-
impairment-when-should-you-report/b96b78e7be21952839fac3aef998fbb8.html
National Association of Drug Diversion Investigators (NADDI). (n.d.). Retrieved from
http://www.naddi.org/aws/NADDI/pt/sp/home_page
National Board for Respiratory Care (NBRC). (2015). Examinations. Retrieved from
https://www.nbrc.org/Pages/examinations.aspx
National Practitioner Data Bank (NPDB). (2015). National practitioner data bank: About us.
Retrieved from http://www.npdb.hrsa.gov/topNavigation/aboutUs.jsp
Keers, Williams, Cooke, and Ashcroft (2013). Causes of Medication Administration Errors in
Hospitals: a Systematic Review of Quantitative and Qualitative Evidence. Drug Saf. 2013;
36(11): 1045–1067. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824584/
Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide
6
Occupational Safety and Health Administration (OSHA). (2015). Guidelines for preventing
workplace violence for health care & social service workers. Retrieved from
https://www.osha.gov/Publications/osha3148.pdf
Office of the Inspector General (OIG). (n.d.). Spotlight on drug diversion. Retrieved from
http://oig.hhs.gov/newsroom/spotlight/2013/diversion.asp
Perz, J. (2014, June 2). Drug diversion in healthcare settings. Retrieved from
http://www.medscape.com/viewarticle/825801
Pinalla, Murillo, Carrasco, and Humet (2006). Case-control analysis of the financial cost of
medication errors in hospitalized patients. Eur J Health Econ. 2006 Mar;7(1):66-71.
Reichgott, M. J. (2005). The impaired physician. Retrieved from
https://www.einstein.yu.edu/uploadedfiles/education/gme/the%20impaired%20physician%20reich
gott%20version3(1).ppt
The Joint Commission (TJC). (2008, July 9). Behaviors that undermine a culture of safety.
Sentinel Event Alert, Issue 40. Retrieved from
http://www.jointcommission.org/sentinel_event_alert_issue_40_behaviors_that_undermine_a_cul
ture_of_safety/
The Joint Commission (TJC). (2009). The Joint Commission guide to improving staff
communication (2nd ed.). Oak Brook, IL: Joint Commission Resources.
The Joint Commission (TJC). (2010, June 3). Preventing violence in the health care setting.
Sentinel event alert. Issue 45. Retrieved from
http://www.jointcommission.org/assets/1/18/sea_45.pdf
The Joint Commission (TJC). (2014, August). Preventing violence and criminal events.
QuickSafety: An advisory on safety & quality issues, Issue Five. Retrieved from
http://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_Five_Aug_2014_FINAL.pdf
Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide
7
Van Den Bos, Rustagi, Gray, Halford, & Ziemkiewicz, (2011) The $17.1 Billion Problem: The
Annual Cost Of Measurable Medical Errors. Health Affairs April 2011 vol. 30 no. 4 596-60.
Retrieved from http://content.healthaffairs.org/content/30/4/596.full
