ACADEMIA Letters

Do Academic Medical Centers Manage According to their

Own Research? Charles Lorbeer, Ph.D.
Charles Lorbeer, PhD

The issue of implementing lessons learned from medical research has plagued medical pro-
fessionals for years (Knottnerus, 1997). This research will present a case study concerning
medical practice management. It will show an application to clinical practice based on over-
looked evidence from an academic medical center’s own research. It is hoped that this case
study can illuminate the need to internalize and implement medical research findings. This
case study demonstrates an example of how research done at an academic medical center was
not consulted or considered when actions were taken concerning the items researched.
In 2017 a study was published by an academic medical center in Florida concerning prac-
tice transformation (Scuderi et al., 2017). The goal of this project was to train six family
medicine practices (doctors, nurse practitioners, physician assistants and their support staff)
on team-based care. The goal was positive practice transformation. In this study, it was found
that common challenges to practice transformation and improved office morale included a
clinic provider or employee dubbed the ‘poison pill.’ The bigger offices in the study noted at
least one person who the medical director felt was obstructive to morale and the unity of the
office. Clinics in the study each reported an inverse relationship concerning the influence of
dysfunctional team members in the office and improved office morale.
Each of the six offices that participated in the study had a pre-test, mid-test, and posttest.
However, the Scuderi et al (2017) study focused only patient safety, diabetes patients’ lab
results, and general lessons learned. There was no reporting on the data concerning office
morale. The larger clinics’ medical directors each noted the presence of a poison pill em-
ployee. According to Scuderi et al. (2017, p. 15) the larger offices “identified at least one
worker who was obstructive to building team culture and cohesiveness. Participating clinics
each reported an inverse relationship between the influence of dysfunctional employees in the

Academia Letters, August 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Charles Lorbeer, PhD, cmsj6731@gmail.com

Citation: Lorbeer, PhD, C. (2021). Do Academic Medical Centers Manage According to their Own Research?
Charles Lorbeer, Ph.D. Academia Letters, Article 3122. https://doi.org/10.20935/AL3122.

1
workplace and improved office culture: For offices that transformed themselves positively, the
morale improved, and the negative influence of the poison pill employee were minimized.”
This researcher wanted to further study the data to determine how the offices compared
with each other on the morale factor. Therefore the research was how the larger offices would
perform on the morale factor. It was noted that the larger offices struggle when there is an
active poison pill. The average of means for all three surveys on the morale questions was
computed for this paper from the data in the Scuderi et al. (2017) study of which this writer
was a contributor.
Table 1 presents the study data. The Likert survey score is noted on the Y axis. The X
Axis notes the various survey questions that relate to morale. These questions are a subset of
the total questions that were asked of respondents. There were two large clinics (Practices A
and B). There were two medium sized clinics (Practices C and F). There were two small clinics
(Practices D and G). This table indicates that Practice A had the lowest morale scores on seven
of the nine survey questions on morale. This confirms the findings of Scuderi et al. (2017)
which noted that an inverse relationship exists concerning the influence of dysfunctional team
members and the lowest performing offices. Scuderi et al. (2017, p. 15) noted in the results
that “two of the practices had (medical director) leadership turnover that affected morale and
operations and was evident in the survey results for those practices.”
Practice A fit this criterion perfectly. Despite the research findings concerning medical
director turn over and the activity of the poison pill, the manager of Practice A was terminated
allegedly due to morale issues. It should be noted that Practice Manager A was very active
and involved in the practice transformation training conducted at their clinic.
While this morale data on each clinic was readily available, it was not previously calcu-
lated nor consulted in this subsequent action against Practice A’s manager. In correspondence,
the Manager of Practice A (2017) had initially reported bullying before the publication of the
Scuderi et al. (2017) research. This was again reported (Manager, 2018) after its publication.
In both cases the manager had alleged ongoing harassment and bullying from the office’s
poison pill. The issue of bullying is very pertinent and has begun to receive attention in the
academic literature. According to Hernandez (2018, p. 35), “Bullying and intimidation are
common in the workplace and often normalized in the culture of medicine.” Hernandez(2018)
describes the prevalence of not addressing bullying in medical settings. In the situation noted
in this study, Manager A who alleged the bullying was fired. Had the leadership of the medical
center reviewed the data on office morale from their own recently completed practice trans-
formation study, a different outcome may have been pursued rather then firing the manager of
Practice A. Especially since this manager had complained before and after the publication of
the study about bullying within the office. “The culture of medicine has normalized intimi-

Academia Letters, August 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Charles Lorbeer, PhD, cmsj6731@gmail.com

Citation: Lorbeer, PhD, C. (2021). Do Academic Medical Centers Manage According to their Own Research?
Charles Lorbeer, Ph.D. Academia Letters, Article 3122. https://doi.org/10.20935/AL3122.

2
dation for many years, and therefore the many forms of intimidation often go unrecognized.
Learning to recognize all forms of intimidation is the first step in prevention and elimination
of these behaviors in medicine” (Hernandez, 2018, p. 35).
Workplace bullying along with the presence of a ’poison pill’ often disrupts and damages
the smooth functioning and productivity of an organization. The impact of intimidation cannot
go unnoticed, unaddressed, and unresolved as it can lead to low morale and thereby lower
work satisfaction and impact a work unit’s productivity. The delay noted in this case study
with an academic medical center implementing the findings of its own study agrees with what
Knottnerus (1997, p. 315) stated, “Although current clinical practice is often evidence based,
there is still much to be gained. Important new evidence from research often takes a long time
to be implemented in daily care, while established practices persist even if they have been
proved to be ineffective or harmful.” Future areas of study using the existing data could look
at the stratification of the medical practices in terms of improvements from survey 1 to 2 to 3.
It is hoped that medical enterprises can be more conscious of the research literature and that
evidence based practice can become a reality rather than a platitude.

Academia Letters, August 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Charles Lorbeer, PhD, cmsj6731@gmail.com

Citation: Lorbeer, PhD, C. (2021). Do Academic Medical Centers Manage According to their Own Research?
Charles Lorbeer, Ph.D. Academia Letters, Article 3122. https://doi.org/10.20935/AL3122.

3
References
Manager, Practice A. (2017, August 22). Complaint to Human Resources, Jacksonville, FL.

Manager, Practice A. (2018, April 30). Complaint to Human Resources, Jacksonville, FL.

Hernandez, Rebecca. “The Intimidation Factor: Workplace Intimidation and Its Effects on
Wellness, Morale, and Patient Care.” Academic pediatrics 18.5(2018): p. 35–36.

Knottnerus, A. “Medicine based evidence, a prerequisite for evidence based medicine. BMJ
1997; 315 doi:https://doi.org/10.1136/bmj.315.7116.1109 (Published 01 November 1997).

Scuderi C., Haddad, C., Bilello, L., Lorbeer, C., Scuderi, G., Shahady, E. “Improving Team-
Based Care in Family Medicine: Lessons Learned from a Practice Transformation Study.”
Osteopathic Family Physician, Volume 9, No. 6, November/December, 2017: p. 12-17.

Academia Letters, August 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Charles Lorbeer, PhD, cmsj6731@gmail.com

Citation: Lorbeer, PhD, C. (2021). Do Academic Medical Centers Manage According to their Own Research?
Charles Lorbeer, Ph.D. Academia Letters, Article 3122. https://doi.org/10.20935/AL3122.