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24. The Chief Resident’s Dilemma 231what had happened and what the issues were from their perspective. Next, I went intothe child’s room to speak with the family. I introduced myself as the supervising residentand asked them to tell me their side of the issue. Through an interpreter, theyrelayed their feelings of mistrust and anger toward the residents. I asked the child’saunt about her accusations of racism and if she had attempted to strike one of theinterns. The family felt their child was being singled out for frequent blood draws thatwere not being performed on other children. She also reported that she had notintended to strike the intern but was merely expressing forceful emotions.I explained that the reason that other children on the unit were not subjected to frequenttests was that they were not as ill as her nephew and that everything done up tothis point would be considered standard care for any child with his diagnosis and clinicalcondition. I also pointed out to her that if someone did not know that it wasaccepted behavior in their culture, the person experiencing her “forceful” emotionaloutbursts would in fact be quite intimidated and fearful. I then asked them what itwould take to reach a compromise in this matter. We eventually agreed that the conflictseemed to arise from a series of miscommunications and misunderstandings. Ioffered to supervise the remainder of the child’s stay personally.The aunt and mother were satisfied with this resolution—feeling that they haddeveloped sufficient trust in me and that an acceptable solution had been found. I thennotified the primary care physician of the events that had transpired and the agreementthat had been made. Finally, I settled down to write a long note to document theconflict.AnalysisLooking at how this situation unfolded, I can see several factors that contributed tothe conflict. First, there seemed to be a lack of communication between the family andthe treating team. This is evident in the family’s view that the child was receiving treatmentdifferent from that given other patients admitted at that time. Another illustrationof this is the family’s lack of understanding of the expected clinical course. Furthercommunication breakdowns occur on both the physician-to-physician level and thephysician-to-patient level, as seen in the family’s overall lack of understanding ofthe treatment plan or clinical course. Last, the family’s concern about racism serves toillustrate the general mistrust the local culture has toward the medical community.There are several examples in the literature of how good conflict management skillscould have avoided such a situation. Merideth and Mantel 1 provide an excellent synopsisof the major issues involved in conflict management. They emphasize that negotiationskills are of critical importance for any project manager. Weiss and Wysocki 2also provide a good review of some of the accepted methods of conflict resolution ina project design. To extrapolate the concepts of project design and management to theclinical setting, anticipation and advanced preparation may have avoided the entireconflict. For example, if the resident team had anticipated the anxieties and apprehensionsof the family, they might have been able to recognize that there was a significantdegree of mistrust directed toward them. Empowered with knowledge, the teamcould have sat down with the family and outlined a detailed treatment plan includingcontingencies for unexpected results prior to the onset of treatment. With regard tothe interaction between the resident team and the primary attending physician, muchof the conflict could have been avoided if they had discussed the treatment plan andthe compromises that had been made.
232 Section VI. Organizational and Interpersonal ConflictOverall, this conflict illustrates that negotiation should be focused on obtaining thebest outcome rather than trying to win. In this case, the best outcome would have beenproper care for the patient and enhanced family satisfaction. Thus, with proper applicationof project management techniques, this conflict may never have occurred.References1. Merideth JR, Mantel SJ. Conflict and negotiation. In Project Management: a ManagerialApproach, 4th ed. New York: John Wiley, 2000:226–58.2. Weiss JW, Wysocki RK. Managing people and project relations. In: 5-Phase Project Management.Cambridge, MA: Perseus Books, 1992.
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Health Informatics(formerly Compute
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Nancy M. Lorenzi Joan S. AshJonatha
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Robert T. Riley PhDJune 26, 1937-Ja
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Series PrefaceThis series is direct
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AcknowledgmentsMany thanks to all t
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xivContentsChapter 5Managing Succes
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xviContentsSECTION VI ORGANIZATIONA
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xviiiContributorsChristopher MoreyS
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Section ICase Studies in Technologi
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Introduction 3and informatics stude
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Introduction 5Leaders have differen
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1GEMINI: The Life and Times of aCli
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1. GEMINI: The Life and Times of a
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Section IIOrganizational ChangeIntr
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Introduction 17The Magnificent Seve
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Introduction 19reducing barriers to
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2The Web Center: A Case Study inStr
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2. The Web Center: A Case Study in
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3. Computers for Kids: Not All Fun
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4Managing ChangeJonathan Becker,Roy
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4. Managing Change 45Because of the
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4. Managing Change 47result, the st
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5Managing Success: An InformationSy
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5. Managing Success: An Information
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5. Managing Success: An Information
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IntroductionJonathan EinbinderIn he
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58 Section III. ImplementationWhat
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60 Section III. ImplementationHow D
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62 Section III. Implementationflow,
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6Bar Coding: It’s Hard to Kill a
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6. Bar Coding: It’s Hard to Kill
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7Developing an EmergencyDepartment
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7. Developing an Emergency Departme
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8Implementation of OpChart in WestM
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8. Implementation of OpChart in Wes
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9. Development of the Scientific Co
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10Early Implementation Problems ofa
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12Managing Change: Analysis of aHyp
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12. Managing Change: Analysis of a
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Comment by James G. AndersonAssessi
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Section IVEconomicsIntroduction . .
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Weak Accounting SystemsIntroduction
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Introduction 139often overran estim
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Introduction 141TABLE IV.1. Example
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144 Section IV. EconomicsTABLE 13.1
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146 Section IV. EconomicsTABLE 13.2
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148 Section IV. Economicsfor an ove
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14Catch 22: The Case of Utilization
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152 Section IV. Economicslonger or
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154 Section IV. EconomicsFor a new
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156 Section IV. Economics7 minStart
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158 Section IV. Economicswork lists
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15Antimicrobial Utilization Program
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162 Section IV. Economicspharmacy.
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164 Section IV. Economicsdifficult.
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166 Section IV. Economicsone area,
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168 Section IV. EconomicsAccording
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16Central Medical Healthcare System
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172 Section IV. Economicsimproves p
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17Building Consensus: QualityImprov
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176 Section IV. Economicsstaff time
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Page 200 and 201: Section VLeadershipIntroduction . .
Page 202 and 203: Introduction 189According to resear
Page 204 and 205: 18Strategic Informatics: Planning f
Page 206 and 207: OptionsOption 118. Strategic Inform
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Page 210 and 211: 19Fix Pharmacy!Jim Carpenter,Tadaak
Page 212 and 213: 20Showdown in the Heart of TexasRob
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Page 220 and 221: 21Mission Valley Medical CenterPhys
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Page 228 and 229: 22. The DNA Donation Project 215dep
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Page 232 and 233: 23. Who’s in Charge? 219• Conve
Page 234 and 235: 23. Who’s in Charge? 221Questions
Page 236 and 237: IntroductionWendy McPheeRecently I
Page 238 and 239: 226 Section VI. Organizational and
Page 240 and 241: 24The Chief Resident’s DilemmaSte
Page 244 and 245: 25Death of a CommitteeRobert Hallid
Page 246 and 247: 25. Death of a Committee 235staff s
Page 248 and 249: 25. Death of a Committee 237While t
Page 250 and 251: 26. Whose Job Is It Anyway? 239all
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Page 254 and 255: 27. All for the Want of a Plan ...
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Page 262 and 263: 29. Founding Fathers Health Corpora
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Page 266 and 267: Conclusion29. Founding Fathers Heal
Page 268 and 269: 258 IndexChange management, (cont.)
Page 270 and 271: 260 IndexHaustus, F., 171-173Hays,
Page 272 and 273: 262 IndexOObservation patients, 152
Page 274 and 275: 264 IndexVesalius Health System (VH
Page 276: Cancer InformaticsEssential Technol
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