When Bruce Reid was hired as Blake Memorial Hospital’s new
CEO, the mandate had been clear: Improve the quality of care, and set the
financial house in order.
As Reid struggled to finalize his budget for approval at
next board meeting, his attention was focus on one issue; the future of six
off-site clinics. The clinics had been set up six years earlier to provide
primary health care to the community’s poorer neighbor- hoods. Although they
provided a valuable service, they also took funds away from Blake’s in-house
services, many of which were underfunded. Cutting hospital personnel and
freezing salaries could affect Blake’s quality of care, which was already
slipping. Eliminating the clinics, on the other hand, would save $256,000
without compromising Blake’s internal operations.
However, there would be political consequences. Clara
Bryant, the recently appointed commissioner of health services, repeatedly
insisted that the clinics were an essential service for the poor. Closing the
clinics could also jeopardize Blake’s access to city funds. Dr. Winston Lee,
chief of surgery, argued forcefully for closing the off-site clinics and having
shuttle buses bring patients to the hospital weekly. Dr. Susan Russell, the
hospital’s director of clinics, was equally vocal about Blake’s responsibility
to the community, and suggested an entirely new way of delivering health care:
A hospital is not a building, ‘she said, it’s a service. And wherever the
service is needed, that is where the hospital should be’. In Blake’s case, that
meant funding more clinics. Russell wanted to create a network of neighborhood-
based centers for all the surrounding neighborhoods, poor and middle income.
Besides improving health care, the network would act as an
inpatient referral system for hospital services. Reid considered the proposal:
If a clinic network could tap the paying public and generate more inpatient
business, it might be worth looking into. Blake’s rival hospital, located on
the affluent side of town, certainly wasn’t doing anything that creative. Reid
was concerned, however, that whichever way he decided, he was going to make
enemies.
1. What sources of power does Reid have in this situation?
Do you believe using legitimate power to implement a decision would have a
positive effect at Blake Memorial? Discuss.
2. What influence tactics might you use if you were in
Reid’s position?
3. Do you see ways in which Reid might use the ideas of
transformational leadership to help resolve this dilemma?
