CASE 3 Leading in a Hostile Environment ployees) but more LEARNING GOALS company under a great deal of debt. This debt allow care Plus a much smaller (4,600 employees) but my This case will help you learn to develop an action plan and cially sound practice operating throughout Arizona evaluate multiple competing objectives during a complicated squire Medical One by taking over andre organizational period a company merger. As a co-manager s financial situation and confident of a project manager tasked with bringing effi Alth health care mergers and acqua ciency and a vision to a newly merged hospital system, you being more and more common-with 243 del will be providing mentoring advice on how to approach a dels 715 billion taking place in the second quarter of cate situation and one that is sure to upset some employees sla d idn't make the process any casier for the After reading the case, you'll prepare a memo that outlines mies involved. The merger between Healthcare Plus your thoughts for how you would proceed as a leader tasked cal One had many potential advantages but carried with creating a new culture that must come together quickly in certain amount of risk as well. There was great resni order for the unit to survive. among the employees of Medical One (some of whom with the company since its inception in 1992) that KEY WORDS COVERED company could come along and just purchase the cal One had grown quickly and was known in its Task performance country for providing extremely high-quality health care Affective commitment vices. Everything they had read or heard through the Trust about Healthcare Plus was oriented around cost cutting and most employees at Medical One, lower costs equated to love Escalation of commitment quality health care Leadership Colleen was not happy about the way management decided to restructure the two companies following the merger Power In order to try to get the best out of both companies-namely, Matrix structure Medicare One's customer service focus and Healthcare Press Organizational culture efficiency and cost containment-the top management had decided to create a matrix structure to operate underping forward. For the most part, managers at Medical One would THE SITUATION continue to report to the same functional directors they had Sitting across the table. Colleen Brooks looked excited and yet before. However, cach manager would now report and se discouraged at the same time. It seemed to be a strange com- to another director as well. The "new" directors were supposed bination of emotions, but it was a look you had come to recto be region-based efficiency experts. Colleen, who had bom ognize over recent weeks among managers you had grown to a highly successful manager of nursing in one of the largest admire over the last few years. Colleen spoke somewhat softly, Healthcare Plus clinics in Santa Fe, New Mexico, had been "I'm just not sure what I'm supposed to do here. I've been put tapped as a new "Regional Director of Nursing Efficiency into this position where I feel I can really make a difference "What a miserable job title!" Colleen thought when she one in a lot of ways, but I also feel like the deck has been stacked nally heard the news. At the same time, this was a big promo inst me. These people just don't trust us yet, and I'm not tion for her and the change would be very positive in sure given the situation that I can blame them. It's partially way for her and her family their fault though! Had Medical One run its business well to Colleen's job was to oversee usine operations in begin with there's a good chance we wouldn't be here. States-New Mexico Colorado Utah and Wyoming of Medical Ons was the largest multispecialty health care prac nursing managers she was sunposed to supervise. Il of tice in the northwest part of the United States. It had numer were at Medical One facilities. The company decided ous regional clinics across several hospitals in seven states and change the "Medical One" name after the merger for man emploved more than 13.000 employees and 900 physicians and continued branding purposes) Fundamentally, in addition to running its own insurance plan. In many ways knew that the reasoning behind the new structure was Medical One would seem to outsiders as a model health care Healthcare Plus's management style and expertise with provider Internally, though, Medical One was in severe finan- One's scale of operations. Although upper mana cial distress. Cost overruns and bad planning had placed the trying to sell the acquisition to everyone inside the Wenger for more ndamiental Codes pertise with Matic 546 INTEGRATIVE CASES ingness to change. This allowed her new tive opinions without fear of recrimination crow companies, almost all of top man came from Healthcare of stuff mich in Mexic, but please en had decided that the first meeting with her new better level of care. Todd Rappen, manager in Grand June w o rant one, and she decided to bring in Colorado was even bold enough to comment all to Denver which was a relatively central location a in such a big deal, why was the group payung where one of Medical One's largest hospitals per nd messing lead of using one of the Dame w she look great care in personally phoning each manager als conference rooms? Colleen known lucing bed and betting the manager know that she was had gone terribly wrong. ms? Colleen knew at that point that things h e r to ing forward to working with them. Some of those man w then that many of the h o were quiet and bestant over the phone, but some seemed she discussed through them t o the local nursing en and receive cited-hout the assis c he Thicco working together to make things better. Sarah Stonefond a tore able to bed their heads in agreement per ist e ne. Women in the indeve pete onions without had been waiting for something like this to happen because As the includ Colleen tried to assure the group the amount of waste I see around here on a daily basis this the first stroomaty on a long road to making mke anyone cringe in disbelief a successful situation for everyone. She tried to set an upbeat In order to make everyone foel more equal, Colleen huone, but it was clear that many people had been up your arranged for the meeting to take place in a Denver hotel. Having of the things that were said during the meeting. There was meeting in the Denver hospital t seemed to contristine nitchyanusys them" mentality as everyone how-she wanted everyone to keep as open a mind as poscatich rights or hop in their cars hle. Plus. Jim Llucci, the nursing manager at the Dev i Colleen had just now begun to grasp the realities of u being in with her direct reports. There were many had already shared that his nursing director was not egited new things she wild have to get used to managing mang about the changes that were coming and Colleen wanted him e mote individuals, managing people who are o feel comfortable in speaking to the group and not looking r over his shoulder. While on the phone call with Jim Colleen report directly to other managers they were more familiar with at their location-in essence, her job was to lead with seem thought. "His operational director doesn't even know what ingly very little power. What she wouldn't have to get used changes are coming! How can she be upset about things that but she didn't want to say anything to though, was upper management expecting her to make haven't even happened yet changes at these locations that would create bottom line until she and Jim had the opportunity to meet in person results in a short period of time. The good thing is that she had Initially, getting together with everyone went extremely lots of experience doing just that. "I know that we have made smoothly. All 14 managers had arrived on time the night before and some had even eaten dinner together and hung out in the many excellent changes at Healthcare Plus without sacrificing patient care-I just have to get others to open up to that idea." hotel bar getting to know one another better. Even though 11 Colleen thought on the plane ride home. of the managers had worked for Medical One, even occupying As you listen to Colleen, it becomes apparent to you that the same jobs, they had actually never met one another before. Colleen was pleasantly surprised to see all of them having a good time and being excited about meeting one another. When she is beginning to question her ability to be able to do this new job effectively. Although you have been in leadership she laid her head on her pillow that night, Colleen thought to development training programs together, the fact is that leader herself. "These people are thirsty for change! They recognize ship is much easier when things are going well for a company that Medical One has issues that need to be addressed and Although there are many potential areas of improwement for it's simply my goal to push them in the right direction toward the new company going forward, it's clear the road is going to accomplishing our objectives." be difficult. Colleen's voice suddenly lowered as she started The next morning didn't go nearly as well. Every time to pack up her things, "Look, I asked you here today to be Colleen mentioned a potential idea that had reduced costs sounding board of sorts, but the truth is I could really use your effectively at Healthcare Plus, it was met with a "that will advice. I don't need an answer right now, but if you could give never work here type of answer. After several rounds of this me your thoughts on things I could do to be a better leader at Colleen's frustration seemed to mount. When the Healthcare this point I would appreciate it You've always given me ered advice in the past Plus managers tried to chime in with evidence that these types of procedures had worked for them in their facility, the Medi- cal One managers seemed to form ranks. It wasn't until it was YOUR TASK too late that Colleen noticed the three Healthcare Plus man. apers were all sitting together at the large U-shaped a c, a four task is a leadership mentor to Colleen is to prepare a seating arrangement that didn't seem to be helping things. Al memo that lays out your thoughts on her situation and some specie courses of action she should consider as she attemats one point Donna Mitchell, a Medical One nursing manager in that kind to start leading her new group. Make sure to give her a memo from Prova Utah even went as far as to say 548 INTEGRATIVE CASES with enough detail so that she understands the reasoning behind your recommendations. Also keep in mind the order in which she should follow these steps. In particular, your memo should touch on the following points. 1. Drawing on what you know about leadership, what types of behaviors are going to be most important for Colleen as she begins to interact with her new direct reports. Should these behaviors change over time? 2. What kinds of power can Colleen use to try to influence others to adopt some efficiency related procedures? Are there certain types of influence behaviors that will be more effective than others given the difficult circumstances? 3. It's clear that the two companies have very different cul tures even though they are both health care providers. Should one culture be stressed over the other wo affect the way Colleen should lead the group? What does Colleen have going for her in terms of gen others to trust her? Are there certain things she show do or say to generate that trust as well as maintain time? How does the new structure affect Colleen's ability lead? It would be useful to detail some of the phos cons Colleen will likely face given how things have organized. 6. Should Colleen focus more on her direct reports' perfor mance or organizational commitment? Will she eshte different behaviors based on that choice? What are the advantages to focusing on one or the other