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CASE STUDY: SYSTEM-LEVEL INTERVENTION

The chair of the pediatrics department in an extensive health system, Dr. Clarice Barna, was struggling with a problem. Three of the 75 residents asked for a meeting with her. During the meeting, the residents complained that they were getting inconsistent instruction from the faculty and not getting the feedback and one-on-one attention from the faculty they felt they deserved. They also thought that the nurses often gave them different instructions than the ones they got from the faculty about patient care. Although three residents were in the meeting, almost all of the talking was done by one resident, Jason.

Dr. Barna set up a meeting with the faculty and shared Jason’s feedback on behalf of the residents. The faculty discussed ways to improve instruction and thought getting additional input from the nurses would be good. The faculty expressed frustration that the residents, although great students, seemed confused when trying to grasp that there can be more than one way to do a procedure. Each faculty member had unique perspectives and practices they wanted to offer the residents and felt the residents needed to understand and accept multiple methods for systems.

Dr. Barna then discussed the situation with the nursing team that often worked with the residents. The nurses said they enjoyed working with the residents and that they were a top-notch group. Upon hearing that Jason was the student who brought this up, the head nurse, Eileen Fenway, reminded the chair that Jason completed his internship at University Children’s Hospital, where the interns were each assigned a specific mentor, coach, and technical instructor in addition to faculty. She suggested that Jason’s perception and expectations needed to be addressed.

QUESTIONS:

Look at the row labeled “Individual” in Table 1-1. Assume that Jason is the individual. Describe how Dr. Barna could improve things by talking only to Jason.
Look at the row labeled “Group” in Table 1-1. Describe how Dr. Barna could engage the group of faculty and nurses to help achieve the goals of improving resident education based on the feedback given by the residents.
Level Focus Goal Methods
Individual Individual’s behavior, perceptions, and emotions. Increase self-awareness and self-management. Coaching, training, mentoring, and feedback.
Interpersonal The relationship and communication between two people. Clarify the nature of the relationship and goals and strengthen foundations for clear communication. Conflict management, mediation, communication, and conflict resolution training.
Group Group goals, tasks, and roles. Clarify the nature of individual contributions, the group’s purpose, and group behaviors that will foster the accomplishment of goals. Education and feedback on the stages of group development, team building, leadership, and coaching behaviors that contribute to team effectiveness and productivity.
Organization Culture, leadership development, and organizational strategy and structure. Increase awareness of the people in the organization that the whole is different from the sum of its parts. Identify what attributes, behaviors, and strategies are necessary to reach organizational goals. Analysis of organizational state, including culture, training in culture change, top team development, and executive coaching. Identify organizational strengths to leverage culture change, appreciative inquiry, and dynamic inquiry.
Community We are finding common ground so that the community can be served. We are building partnerships and collaborations across communities to deliver services. Strategic planning, community development, and futuring.
TABLE 1-1 Intervention at Each Level of System

 

SCIENCE
HEALTH SCIENCE
NURSING
HSCI- 230-04N