Using a well-designed PowerPoint presentation answer the following questions regarding the Western Pediatrics Case Study:

1. What's going right, and what's going wrong?

2. Provide your recommendations for how the team might move into a phase where its performance is improved.

3. What metrics would you use to measure this team's performance?

4. What key leadership skills are necessary to get this team to perform?

minimum 8 slides excluding title and reference with references

Reference:

Western Pediatrics is a five-clinician pediatric practice in rural Ohio. The practice serves a largely middle-class suburban population and prides itself on providing preventive services. One of the physicians recently attended a continuing medical education program on preventive services. Upon her return, she decided to assess the practice's performance in this area. She and the other physicians were surprised when she distributed the results. Among the findings were:

1. 60% of children were behind schedule, and at least one immunization
2. Vision screening was conducted and recorded for only 15% of children
3. 50% of children were screened for anemia
4. 25% of children had their blood pressure recorded in the patient record
5. 13% of children were screened for lead

While the pediatricians were bewildered by these findings, the medical record and nursing staff found them consistent with their impressions. The findings were presented and discussed at the monthly staff meeting. Two physicians combined saw about 40% of all patients were adamant that their patients were current in preventive services, and there was no need for practice-wide effort to improve their preventive service rates. Unfortunately, the data were not linked to individual physicians, and thus, there was no way to verify their claim. Nonetheless, it was agreed that staff, including the two reluctant physicians, work as a team to address the problem.

The first meeting was scheduled over the noon hour. One of the physicians arrived at 12:20, while two others left early at 12:45. One of the nurses was out sick. No decisions were made, and the entire meeting was spent attempting to find a date and time for follow-up meetings.

At the next meeting, one physician stated that during an acute visit, physicians do not have time to review the medical record to determine if a patient is behind on any preventive services. The other physicians agreed and decided that a form should be developed listing all preventive services, and this should be attached to the medical record. The nurses worked together after the meeting to design the form, known as a preventive services chart (PSC).

Three thousand copies of the PSC were printed. When the physicians saw the form, they indicated it was poorly designed. Not all relevant services and immunization schedules were included. The forms were destroyed, and the physicians asked the nurses to redesign the form. The nurses consulted with the physician who attended the continuing education seminar to obtain information on the recommended preventive protocols. Based on this information, the form was redesigned, and the immunization schedule and other information were added. Confident that this was the right form, 3000 copies were again printed. When presented to the physicians, it was discovered that there was little agreement among them, and an argument broke out at the next meeting about the immunization schedules and screening protocols.

After this meeting, one of the nurses, in consultation with two physicians, developed another form of separate columns for each physician's preferred preventive services protocol. Hearing about this new procedure informally over lunch, the medical records staff was skeptical about its feasibility. Moreover, when one of the nurses asked a physician when nurses would record this information, she was told, "Nurses have it too easy in this practice. You have a great deal of downtime and can find time to prepare charts for the next day's patients."

During the next three weeks, the following events transpired:

1. Nurses complained to the physicians that the medical records staff were not making records available to them in time for the preventive services review.
2. Medical records staff complained 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.
3. 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 a significant number of cases for which information was provided.
4. Nurses spent an additional 1 to 2 hours in the office preparing the next day's files. They complained that the medical records were tough to decipher. They requested and were denied overtime pay.
5. Confusion was rampant when files were prepared for one physician, but another saw the patient. An even more difficult problem was caused by drop-in patients, for whom record reviews were not prepared. Nurses spent up to 30 minutes reviewing these drop-in charts and recording the information on the PSC.
6. Two weeks after the system was implemented, one nurse quit abruptly at three o'clock and walked out.
7. One physician gave each parent the PSC and asked parents to record preventive services since the physicians were too busy to keep track of this.

After a month, the team met again. The physicians decided that the solution caused more problems than it solved. They decided to disband the team and individually work on the preventive services problem.