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Week Five Writing Assignment: Western Pediatric Case Study Analysis

BHMC 433-303A Principals of Healthcare Management

10/31/2022

Katlyn Kiger
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Western Pediatric Case Study Analysis

Introduction

To be an effective team it is important to work as one cohesive group to obtain goals set

by the facility. Western Pediatrics is a pediatric facility that has five doctors practicing medicine

to children in the local area of a rural city in Ohio. This facilities patient population generally is

directed towards the middle-class suburban population. Western Pediatrics strives to excel on

providing excellent preventative care to the children that they serve. One of the doctors recently

attended a conference on medical education programs. Therefore, once she returned to Western

Pediatrics in Ohio, she took it into her own hands to see the practices performance around

preventative care for children in their community. The employees of Western Pediatrics were

shocked at the findings of the quantity of preventative care provided to the children who were

patients at their facility.

Findings

The doctor found that “60% of children were behind schedule and at least one

immunization, Vision screening was conducted and recorded for only 15% of children, 50% of

children were screened for anemia, 25% of children had their blood pressure recorded in the

patient record and 13% of children were screened for lead. Even though the doctors were

flabbergasted by the results the nurses were not surprised by the statistics. The nurses stated that

they were consistent with their impressions. The doctor who dug into the results of the accuracy

of preventative care that was offered to their patients decided that it was time to change things

and decided to bring it up at their next staff meeting.

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During the first meeting, it was brought up that two of the five physicians who practice at

Western pediatrics see about 40% of the pediatric patients who are seen. Both doctors were very

resistive to the findings and insisted that their patients received top notch preventative care. They

stated that was no need to change the way they provide preventative care because were current

and up to date to all preventative services. During this meeting the ones who were in attendance

was all the nurses besides one, the two doctors who were admet that they provided excellent

preventative care, one doctor who was over twenty minutes late, and two other doctors who left

twenty minutes early. The main topic of the first meeting was finding a time to have their second

since the attendance wasn’t what they needed. Although, all the staff did come to agreement that

changes needed to be made to ensure all patients are receiving five-star preventative care.

Over the next couple weeks, they continued to have meeting to practice wide effort to

improve their preventive service rates. Over the next three weeks many events occurred such as

nurses complained to the physicians that medical records staff were not making records available

to them in time to do the preventive services review, medical records staff complaints to the

physicians that nurses were unrealistically requesting the next day’s charts at 9 AM so they could

spend the day preparing for the next day's patients. They also reported that nurses were rooted in

their requests. Physicians complained among themselves that preventive services information

was absent for almost half of the patients, and they suspected that the information was inaccurate

for significant number of cases for which information was provided, nurses were spending an

additional 1 to 2 hours in the office preparing the next day’s files. They complained that the

medical records were very hard to decipher. They requested, and were denied, overtime pay,

confusion was rampant when files were prepared for one physician, but another physician ended

up seeing the patient. An even more difficult problem was caused by drop-in patients, for whom
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record reviews were not prepared. Nurses spent up to 30 minutes looking over these drop-in

charts and recording the information on the PSC. Two weeks after the system was implemented,

one nurse quit abruptly at three o'clock and walked out and lastly one physician gave each parent

the PSC and asked parents to record preventive services themselves since the physicians were

too busy to keep track of this. By the end of the month, it concluded by the physician that the

solution caused more problems than it solved. They decided to disband the team and work on the

preventive services problem individually.

Analysis

Healthcare workers are often very resistant to change. Although, with the way the

healthcare world changes frequently it would be assumed that the healthcare workers are

adaptable. This team made a solid effort to try and improve their preventative care numbers but

were lacking a sole leadership role to enforce what that staff does and does not do. It appears that

the changes were phrased as an option when it should’ve been a all hands in team effort that had

repercussions if the new policy wasn’t enforced. They worked very hard to come up with

different options when the doctors pushed back but it was not left in effect long enough for the

staff to adapt. Based off how the article worded things, it seemed like every week when the staff

pushed back and then the staff changed tactics on how to improve preventative care. There are

few recommendations in order to be successful. They are to improve team effectiveness, and a

designated team leader that promotes a team atmosphere and team performance.

Team Effectiveness

According to “Interventions to Improve Team Effectiveness within Health Care: A

Systematic Review of the Past Decade,” states that over the past decade, the literature on team
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interventions has rapidly evolved. This article is based on a study that took place between years

2008 to 2018. It uses 6025 studies; 297 studies met the inclusion criteria according to three

independent authors and were subsequently included for analysis. The Grading of

Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level

of empirical evidence. The article states that there are three types of interventions were

distinguished. First point is training. This is sub-divided into training that is based on predefined

principles such as. CRM: crew resource management, TeamSTEPPS, team strategies, tools to

enhance performance and patient safety on a specific method (i.e., simulation), or on general

team training. Secondly tools cover tool that structure such. SBAR: situation, background,

assessment, and recommendation, debriefing checklists, and rounds, facilitate through

communication technology, or trigger through monitoring and feedback, and teamwork. Lastly,

organizational redesign is about redesigning structures to stimulate team processes and team

functioning (Doekhie, & Wijngaarden, 2020)

A programmer is a combination of the previous types. Most studies evaluated a training

focused on the (acute) hospital care setting. Most of the evaluated interventions focused on

improving non-technical skills and provided evidence of improvements. The conclusion of this

study was that over the last decade, the number of studies on team interventions has increased

exponentially. Research often to focus on certain interventions, settings, and outcomes.

Principle-based training (i.e., CRM and TeamSTEPPS) and simulation-based training provides

the greatest opportunities for reaching the improvement goals in team functioning. Using this

information to improve the outcome to improve preventative care at the Western Pediatric to

reach the common goal (Doekhie, & Wyngarden, 2020).

Team Leader
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According to, “Differential treatment Within Sports Teams, Leader–Member (coach–

player) Exchange Quality, Team Atmosphere, and Team Performance,” uses the leader member

exchange theory as a framework. The study focuses on the differential treatment that leaders

have on social and task related issues within the team. It was found that the team members'

perceptions of the frequency and degree of social and task-related differential treatment by the

leader were associated with their evaluation of team atmosphere and team performance, in

addition to the effects of the quality of their own working relationship with the leader. Team

leaders who engage in many different behaviors intended to increase team effectiveness,

including structuring the team, helping individual members improve their contributions to the

team, and working with the team. One tells sign of an effective leader is a good working

relationship with individual people who make up the team. Good working relationships may lead

to greater individual enthusiasm and team cohesion as well as better performance (Breukelen,

Leeden, Wesselius, & Hoes 2012).

Conclusion

The Western Pediatric facility worked diligently trying to improve the preventative care

of the adolescence who are patients of the facility. Although, none of the ways they tried to

implement change were able to be used long term because of the staff being resistant to change.

With change being implemented as both articles explained the options to be a successful team to

be able to enforce policy in relation to increase preventative care to adolescence. To be

successful they need an effective designated team leader and increased team effectiveness.
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References

Buljac-Samardzic, Doekhie, K. D., & Van Wijngaarden, J. D. H. (2020). Interventions to

improve team effectiveness within health care: a systematic review of the past decade. Human

Resources for Health, 18(1), 2–2. https://doi.org/10.1186/s12960-019-0411-3

Van Breukelen, Van der Leeden, R., Wesselius, W., & Hoes, M. (2012). Differential treatment

within sports teams, leader-member (coach-player) exchange quality, team atmosphere, and

team performance. Journal of Organizational Behavior, 33(1), 43–63.

https://doi.org/10.1002/job.735