Smart Car Case & Question Solution

The Teaching Hospital[1]

Dr. Robert Uric was the head of the Renal Medicine Unit at a large university medical school and teaching hospital. The teaching hospital, a regional medical center, had over 1000 beds and was considered a reasonably prestigious medical facility. There was a steady undercurrent of hostility and competition between the hospital and the medical school. The two institutions, a state school and a state-supported hospital, had only one top official in common—the provost. From the provost down, the organization split in half, with the medical school, its physician faculty, and its nursing faculty on one side, and the hospital administrator, nonmedical hospital employees, and ancillary service staff on the other (see Figure 1). The physical plant, designed in the shape of an H, paralleled and accentuated the organizational structure. The medical school ran east-west, ten floors high on the north side, and the hospital ran east-west, eight stories high on the south. They were connected only by the bar of the H, an officeless corridor connecting the medical school and the hospital on each of the first six floors. A large part of the problem was the unusual nature of the financial arrangements. The physicians, as faculty members, received salaries, but no money for patient services. Patients were billed for professional services, but the revenues went into departmental funds which were disbursed at the discretion of the department chairs. The hospital, on the other hand, turned in every patient-revenue dollar to the state and then had to turn around and beg for, and account for, every penny of operating revenue it got. Grant monies further complicated the situation, especially in the area of salaries. Hospital employees were civil service workers, strictly regulated by job classifications and wage scales; no exceptions were made.