In late Summer, Dr. James Klemm, Chief of Medicine at Lawrence University Medical Center (LUMC), was wondering what he had gotten himself into. Dr. Klemm felt he was over-involved in trivial issues in running the service and seemed to be spending an inordinate amount of time in meetings. He reflected that these activities were related to substantial changes in medical center management that began in about a year ago, with the introduction of LUMC's Patient Centered Redesign Program. The Department of Medicine became involved shortly after the start of the program. Although Dr. Klemm saw a number of positive changes, he was annoyed by the increased demands placed upon him by Medical Center Administration and the Patient Centered Redesign Program. He was now faced with a list of problems and recommendations for change that had been developed out of Patient Centered Redesign Program activities and he wondered not only about each of the possible changes, but also his changed role in managing the service.
The Medical Center
Lawrence University Medical Center was an 850-bed private hospital that was the primary teaching affiliate of Lawrence University's schools of medicine and nursing. The medical center had an excellent reputation in the community and was financially sound. It offered a full range of services, and had major programs in cancer care, cardiology and trauma. Located in an inner-city urban setting in the Northeast, LUMC had experienced a dramatic shift in its patient population, in patterns of referral in the city, and in funding for patient care and research. Managed care had grown dramatically, and LUMC experienced substantial competition from St. Joseph's Hospital, as well as pressure from HMOs to reduce length of stay and costs. St. Joseph's aggressively marketed its services in the region and successfully underbid LUMC in several recent negotiations with HMOs.
LUMC was organized along traditional lines, with the major components of the organization being departments representing specialized functions, disciplines and professions (See Exhibit 1). These departments each reported to one of several vice presidents, who in turn reported to an executive vice president, who reported to the medical center President/CEO. In addition, medical staff departments, each led by a salaried chief, were part of both the LUMC medical staff governance structure and the Lawrence School of Medicine. Chiefs of clinical services were also either chairmen of their respective medical school departments or sub-specialty division directors.
Patient Centered Redesign
With the support and participation of the President/CEO, a multi-disciplinary planning group developed a proposal that resulted in the award of a $1 million grant in a program to encourage hospital innovation, sponsored jointly by the Robert Wood Johnson Foundation and the Pew Charitable Trusts. Chaired by the VP/Nursing, the planning group proposed to improve patient care through development of a new management structure for LUMC, as well as implementation of multi-disciplinary patient care teams, cross-trained multi-skilled employees, and a continuous quality improvement (CQI) approach to analyzing and re-engineering patient flow and support systems. Two attending physicians, one of whom was a member of the Department of Medicine, participated in the planning group, but no chiefs were directly involved. . . .
- There are no assignment questions for this case.