A CHANGE OF SEASON
CHAPTER 3
Code Blue
Health Science Edition Four
New Characters
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Let’s briefly review each new character:
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Wes Douglas
Dr. Emil Flagg
Helen Ingersol
Birdie Bankhead
David Brannan
Roger Selman
Wes Douglas’ First Interview
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Before being offered the job as interim
administrator, Wes was offered a job as a
hospital consultant.
Before the interview, Wes reflects on the brief
experience he had with Hap Castleton prior to
his death. What was his opinion of Hap?
Wes Douglas’ First Interview
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During his interview for the job of hospital
consultant, Wes was interviewed by Edward
Wycoff, chairman of the finance committee, and
by Dr. Lindsey Reese, who Wycoff had invited
to the dinner.
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Let’s review some of the areas of hospital weakness
that Reese wanted Wes to work on. (These areas
dramatically impact the way nurses and doctors
perform their jobs.)
Areas of Weakness
Quality Assurance
 Quality assurance begins with the establishment
of standards.
 Standards include . . .
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____________________
____________________
____________________
____________________
Areas of Weakness
Continuous Quality Improvement
Continuous Quality Improvement
(CQI)
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A BIG topic in healthcare delivery.
Every healthcare professional should understand
the elements of CQI to succeed in their jobs.
In most hospitals, healthcare professionals are
required to know the philosophy and
terminology of this important program.
Features of
Continuous Quality Improvement
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Designed to improve the quality of products and
services
Used in both manufacturing and in hospitals
Based on the philosophy that quality can
continually be improved – it does not subscribe to
the philosophy that “if something isn’t broke don't
fix it”
Features of
Continuous Quality Improvement
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The emphasis is on future results
The philosophy believes that most problems are
caused by processes and not by people
Quality is defined by exceeding the expectations
of physicians and patients
Features of
Continuous Quality Improvement
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Uses statistical tools to uncover problems
When a problem is uncovered, the hospital
administrator selects a team to identify each step
in the process
The team then designs steps to
correct the problems
Features of
Continuous Quality Improvement
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Standards are established so that future
problems do not occur
A program to measure performance to
determine the standards are being met is
established
The steps are: plan, act, do and check
History of
Continuous Quality Improvement
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Continuous Quality Improvement (CQI) was
first developed by an individual named
W. Edwards Demming.
His objective was to improve quality while
making work more fun.
History of
Continuous Quality Improvement
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Demming took CQI to the American
automobile industry, who rejected it.
At that time American automobile makers
dominated the world and were not interested in
improving quality.
History of
Continuous Quality Improvement
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Demming then took it to Japan where Japanese
automakers implemented it.
In the following years, the Japanese automobile
industry almost put the American automobile
industry out of business, based on the quality of
their products.
History of
Continuous Quality Improvement
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Finally, American manufacturers saw that unless
they improved the quality of their products, they
would no longer be able to compete in global
markets, and so they too adopted continuous
quality improvement.
The healthcare industry subsequently adopted
continuous quality improvement.
Areas of Weakness
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One way of measuring the quality of care
offered by a hospital is to look at morbidity and
mortality.
Other Areas of Weakness
Identified During First Interview
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HIPAA
EMTALA
Risk Management
HIPPA
Health Insurance Portability and
Accountability Act of 1996
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When was it passed?
What was its objective?
What does it do?
What information is protected?
HIPPA
Health Insurance Portability and
Accountability Act of 1996
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Who is covered under the act?
What are the penalties?
EMTALA
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Stands for The Emergency Medical Treatment
and Active Labor Act
The act is designed to prevent what is known as
“patient dumping.”
Under the act, hospital emergency rooms must
provide (without regard for the ability of the
patient to pay) stabilization and emergency
treatment when a patient presents themselves at
an emergency room for emergency care.
Risk Management
Risk management involves:
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Identifying potential risks (such as falls, infections,
and so on).
Analyzing those risks
Establishing priorities for addressing those risks
Bringing resources to bear in reducing or eliminating
those risks
Why do organizations like
hospitals do the things they do?
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When working in a hospital, it is useful to understand
why the board or management takes the actions they
do.
Without a doubt the doctors, nurses, and other
employees are concerned about who will be their new
administrator.
Put yourself in the place of the employees of Brannan
Community Hospital. What difference does it make to
you who is chosen to be the new hospital
administrator?
Employability Skills
Employability Skills
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Although he doesn’t
know it, Wes Douglas is
about to be interviewed
for a job.
If you haven’t already, all
of you will eventually
face the employment
interview.
What do you think all
employers look for in a
new employee?
What Do Employers Look For?
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Ability to do the job
Ability to get along with
people
Willingness to fit the
corporate culture
Integrity and loyalty
Adaptability to change
Let’s discuss each of these in a little more detail.
Ability To Do The Job
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Aptitude
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Defined as the natural
talent or ability to learn
easily and quickly; a set of
factors which can be
assessed and which show
what occupation a person
is best suited for.
Education and Training
Experience
Aptitude
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Different people have different skills.
Individuals with strengths in one area often have
weaknesses in another.
A person who is good with mechanical concepts
may not be a good writer.
An individual who is excellent in math may not
have good people skills.
A person who is good with people may not be
good in science.
Aptitude
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Some people spend a
great deal of time
qualifying for a specific
occupation, only to find
they don’t enjoy the
work.
They lack the aptitude
for that particular job!
Aptitude
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How does one avoid making a mistake when
selecting a career?
I spent all these years
going to school, but now
that I’m here,
I hate my job!
Education and Training
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Most professional healthcare jobs require some
form of licensure and certification.
Professional associations such as the American
Medical Association, the American Nursing
Association, and the American Hospital
Association can help students identify the
requirements for a specific profession.
Education and Training
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Obsolete
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Knowledge is
expanding at an everincreasing rate.
Much of what one
learns in school will
be obsolete within
fifteen years of
graduation.
Education and Training
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What, then, should a
student take away from
formal education?
Experience
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Depending upon the job,
some employers will
require real world work
experience before they
hire an individual.
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Internships can often
satisfy this requirement.
Ability To Get Along With People
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Do you know that the
main reason people are
fired is not their lack of
technical skills, but their
inability to get along with
people?
Willingness to Fit into the Corporate
Culture
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What is “corporate culture?”
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It is “the way we do things
around here.”
The corporate culture of
IBM is different from
the corporate culture of
Microsoft.
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How?
Integrity and Loyalty
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What special characteristics of the healthcare
industry make it important that physicians,
nurses, and other healthcare employees be
individuals of integrity and loyalty?
Adaptability
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What special challenges
does the healthcare field
face that mandate
employees be able to
adapt to new conditions?
Adaptability to Change
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New technology, global
competition and changing
national and world
economies continually alter
the way things are done.
Employees must have a
commitment to lifetime
learning and must be willing
to adapt to an environment
that is continually changing.
Adaptability to Change
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The only constant in
the modern world of
work is change.
Medical Terminology
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Did you know that many
medical terms have
Greek or Latin roots?
Students can increase
their understanding of
terminology by
memorizing a few basic
root words.
Medical Terminology
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Example
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Nephr = kidney
itis = inflammation of
Nephritis = inflammation
of the kidney
Learn root words on
pages 42-43.
Discussion Question 1
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Edward Wycoff felt that Hap
Castleton and Wes Douglas
would make a good team, as
each would complement the
strengths and weaknesses of
the other.
With this in mind, discuss the
relative strengths and
weaknesses of Hap and Wes.
Discussion Question 2
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Edward Wycoff related
the story of several vice
presidents of a large
Fortune 500 company
who were successful
within the structure of
that company, but lost
their fortunes when they
attempted to go into
business for themselves.
[Continued]
Discussion Question 2
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Why did this happen,
and what can an
administrative person
learn from this
experience?
Discussion Question 3
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Why would a young CPA entertain an offer to
serve as interim administrator of the Brannan
Community Hospital?
What does Wes have to win by accepting this
offer, and what might he have to lose?
Place yourself in the role of Wes Douglas.
Would you accept the offer?
Discussion Question 4
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Assuming that
Roger Selman had
to be fired, what do
you think of
Wycoff's timing?
Discussion Question 5
It has often been said, that how someone does
something is as important as what he or she does.
 If you were chairman of the board, would you fire
Roger Selman?
 If not, why not?
 If so, is there anything you would do differently?
Discussion Question 6
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While Edward Wycoff was
willing to blame Roger
Selman for the hospital’s
financial problems, Roger felt
that the board shared
responsibility for the
hospital’s poor financial
condition.
What might the board of
trustees have done to avoid
the crisis described in
Chapter 3?
Discussion Question 7
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What was the reaction of the hospital’s employees to
the appointment of Wes Douglas as administrator?
What might the board have done to make the
transition easier for their new administrator?
Discussion Question 8
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As long as the board
does the right thing, does
it matter what the
employees or the medical
staff thinks?
Discussion Question 9
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Where does real
authority come from, a
title, or credibility?
Discussion Question 10
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What will Wes Douglas
have to do to build his
credibility with the
board, the medical staff,
and the employees?
Discussion Question 11
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As long as an allied
health employee has
good technical skills, is it
important for him or her
to have good
communication skills,
and some political savvy?
Discussion Question 12
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Birdie Bankhead, Hap Castleton’s secretary,
believes that Edward Wycoff may have had
ulterior motives in selecting Wes Douglas to be
the new hospital administrator.
What might these motives be?
Assuming that Bankhead is correct, what can
Wes do to protect himself?
Discussion Question 13
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What is the difference
between a fixed price
contract and a cost
reimbursement contract?
Who loses money if
there is a cost overrun
under a fixed price
contract?
Who loses under a cost
reimbursement contract?
Discussion Question 14
Identify the root words of each of the following
terms. From the roots, explain what you think the
term might mean. Using a medical dictionary, write
the actual definition.
cystitis
hematology
orthodontist
liposuction
ophthalmologist pathology
tracheoscopic
gingivitis
necrosis
hypodermic
necrophobia
histology
Discussion Question 15
Assume you are a healthcare practitioner talking to the
patient of someone with no medical training about a
loved one. Translate the following into “simple English.”
a. I believe your 100-year-old aunt is necrophobic.
b. The child was cyanotic at admission.
c. Your father was suffering from apnea when he
called us.
d. Your son has severe gingivitis.
Discussion Question 16
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Roger Selman argued that it was justifiable to
sign a contract with the Mountainlands
Insurance Company at a price that was lower
than hospital cost to maintain its volume of
patients.
Do you believe this was an appropriate decision?
Discussion Question 17
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Consider the way
Edward Wycoff leads his
board and staff.
Does he have the
attributes of a successful
long-term leader? Why
or why not?
Discussion Question 18
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What made Wes Douglas successful in his
communication with Birdie Bankhead in this
chapter?
Writing Exercise 19
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Assume that you are in the
role of Edward Wycoff as he
fires Roger Selman. Using the
reasons given in the chapter,
prepare a script of the
conversation you would have
as you let Roger know that
he was being terminated.
Demonstrate kindness,
understanding and courtesy
in place of the tactics Wycoff
used.
Writing Exercise 20
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Using the tools taught in
Supplementary Discussion 1—
Employability Skills, develop a
plan to explore a specific
health care career. Consider:
(a) personal aptitudes, (b)
education and training
requirements, (c) pay and
employment opportunities,
and (d) work environment.
Role Playing 21
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Select a team of six or more people to role-play
the board of trustees of Brannan Community
Hospital and the administrator before the class.
Have the board develop a plan to save the
hospital in the next 30 days. Address the
following problems:
1) the hospital is not generating enough cash to pay its
bills.
2) employee morale is at an all-time low.
Role Playing 21 (cont.)
3) the newspaper is running unfavorable editorials
about the operations of the hospital.
4) the community is losing confidence in the quality of
services provided by the hospital.
5) there is talk of an initiative to close the hospital
down.
The End!