Posted: May 25th, 2022

Improving Services at Urban General Hospital

Consulting Case Study

Improving Services at Urban General Hospital

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Case Overview

Urban General Hospital has initiated an intervention designed to make their organization more user-friendly for patients and their families. This intervention requires department heads to work together and meet with the CEO on a regular basis. Response and attendance at these meetings has been sparse, with one particular Department head voicing a negative opinion of the meetings and their productivity. In order for the new intervention to have the intended affect, all employees and managers must be supportive of the new program. The CEO places the blame on one person, but this behavior may be indicative of a larger problem within the organization. The following will examine the key issues involved in the situation.

Key Issues

In the entry/contract phase of the consultation, it is difficult to determine the root cause of the problems that face Urban General Hospital. However, from the preliminary information thus far, it appears that the problems can be divided into three distinct issues. The following will discuss these issues in detail, as well as the potential strategies for devising a solution to them.

Issue #1

The first issue is perhaps the most important in this case. It is apparent that some issues existed prior to the problems with Spike. The current problem arose as a result of an intervention that was presumably to resolve an existing issue. The key issue is not the problem with Spike. The key issue is why the intervention was needed in the first place. At this point, no information has been given that explains why the hospital felt the need to launch this large-scale intervention.

From the explanations that were given regarding the intervention, the scale of the project provides clues that something large-scale was needed. It is not known whether the need for the intervention arose as a result of customer and/or patient surveys, litigation, of declining revenues. The reason for the intervention is the primary issues that need to be addressed in the consultation. There is obviously an underlying problem that needs to be addressed, beyond the problems with Spike. However, further investigation will have to be performed to determine the nature, scope, and previous interventions in connection with the problem.

The first phase of the investigation will involve a more detailed interview with senior management to determine the reason for the intervention a strategy will be developed to help resolve this underlying issue, regardless of the current problems with meeting attendance. The purpose of the investigation will be to determine the root cause of the problem being faced by Urban General regarding customer/patient relations.

Issue #2

From the reports by Spike that the first two meetings were “going nowhere” it is apparent that the intervention needs a better sense of direction. The reaction of Spike may indicate a lack of clear objectives and strategy on the part of the CEO and the department heads. There is an apparent need to develop a clear and measurable objective, as well as a clearly defined strategy for getting there. This may help to alleviate frustration and the feeling that nothing is being accomplished in the meetings.

Spike is voicing an opinion that may be shared by others in the meetings, but only Spike was willing to speak out on the issues. His rejection of the method should not be taken as an affront by the CEO, but rather an extreme form of constructive criticism. If the committee has a set of objectives and a clear strategy, it needs to communicate this directly to the meeting attendees. If meeting attendees can see progress towards a clear end goal, they will feel as if they are approaching a resolution to the underlying problem addressed in Issue #1.

When people do not know what the end goals is, or how they will get there, it can lead to frustration. This is the underlying cause for Spike’s reaction. Spike, and possibly other meeting attendees need to feel as if they are accomplishing a common goal. The only way to achieve this is to make certain that the department heads know where they are headed and how they will get there.

Although Issue #1 and Issue #2 may appear to be interconnected, they are not connected in reality. Issue #1 has to do with a macro view of the situation, as it affects the entire hospital. Issue #2 is necessary in order to fix the problems with issue #1, but it is limited to the focus and goals of the department heads. The department heads need to develop a unified approach, not only concerning the current issue, but also in the manner in which they approach subsequent issues in the future.

They need to employ good problem solving skills in this and all of the future challenges that they will face. From this perspective, Issues 1 and 2 may be related in this instance, but both reflect two completely unrelated issues on a macro level. The department heads need to learn to work together for a common purpose and to set clear objectives and develop their strategic planning skills.

Issue #3

The third issue in the case is that the CEO needs to gain support for the interaction. The department heads need to feel a sense of ownership of the larger problems being faced by the organization. Spike cannot be considered an issue in the case, but rather a symptom of the issue. No information was given as to how the decision arrived that the hospital needed a large-scale intervention. It may be that the department heads do not share in the CEOs concern for the urgency of the problem. At this point, we do not know if the decisions have been made by the CEO alone or by an agreement of the department heads. Either way, department heads may not feel that sense of ownership that is necessary to have an effective team.

The CEO needs to build a sense of team cohesion among department heads and other employees in the organization. They need to feel a sense of ownership of the problem and a sense of ownership in the resolution. Like issue #2, this is also a necessary step in solving the macro issues involved in issue #1, but resolving this issue alone will not solve all of the ills of the hospital.

Clues were also provided that indicate a need for better communication skills among teams members. Rather than giving notice that he would not be attending, Spike waited until cornered and confronted about his lack of attendance at the meeting. The fact that the CEO had to track him down is a symptom of a lack of a sense of team and a symptom of poor communication skills within the group. It is apparent that Spike did not feel that he was a part of the group, or that he was needed by the group. This also supports a lack of team cohesion among he hospital staff.


Problems that are present in upper management are often indicative of problems within the rest of the organization. Issues 2 and 3 are not limited to the resolution of Issue #1 in this case, but are problems that need to be addressed on all levels of the organization in a manner that will continue to become a part of organization long after the current culture is resolved. The organization is in need of a resolution that will result in long-term changes in the way managers and staff reacts to and communicates with one another. They need to learn to function together as a team, not only to resolve the current crisis, but also to help them resolve any problems or issues that should arise in the future as well. The “Spike Problem” is not a problem with a single person at all, but rather a reflection of an organizational culture that is not conducive to problem solving and effective team strategies.

As Peter Block states, the consultant must strive to build the capacity of the clients to make their own assessments and to resolve their own problems (Block, 1999). Resolving issues 2 and 3 will help Urban General to build the capacity to help themselves not only resolve issue #1, but will help them to be better problem solvers for any issue that should arise in the future. The employer/employee relationship is emerging as one of the most important issues that a consultant must face (Boss, 1985). This relationship is a central issue in the above outlined case. Healing this relationship will give the company many more options when issues arise in the future (Dougherty, 1999).

Resolving these three primary issues will pave the way for the company to develop better problem solving skills in the future that they can apply to become a more effective team. This will translate into an organization that provides better service to its patients and other stakeholders in the future. These issues are the key issues faced by the hospital, and it is the job of the consultant to give them the necessary skills to make themselves into a better organization than existed before these issues arose.


Block, P. (1999). Flawless Consulting: A Guide to Getting Your Expertise Used. New York, New York: John Wiley & Sons.

Boss, R. (1985). The psychological contract: The key to effective organizational development consultation. Consultation: An International Journal, 4: 284-304.

Dougherty, M. (1999). Psychological Consultation and Collaboration in School and Community Settings. Australia: Cengage Learning.

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