1. Code Blue Health Science Edition Four
A Change of Season
Chapter 3
Code Blue Health Science Edition Four
In this chapter we are introduced to Wes Douglas, who will soon become the new interim hospital administrator. An interim administrator is a temporary administrator, someone chosen to serve in that role until a permanent replacement is found.
We will also learn about the financial problems the hospital is facing. Many small rural hospitals continually operate on the edge of financial failure. They lack the management and resources to compete in a modern competitive environment. In addition, we will find that the hospital has failed to take the steps to determine what their costs are, given changes in the way they are paid by employers and government programs.
We will be introduced to the board of trustees, the group ultimately responsible for the operation of the hospital. We will learn that members of boards of trustees are usually not chosen for their expertise in healthcare. Instead they are chosen for (1) their personal wealth—their ability to make financial contributions to the hospital, (2) their expertise in other areas of business, (3) their political influence in the hospital and/or the community, and (4) their ability to represent different groups within the community (minorities, the business community, prominent local employers or unions, and so on.

2. New Characters Let’s briefly review each new character: Wes Douglas
Dr. Emil Flagg
Helen Ingersol
Birdie Bankhead
David Brannan
Roger Selman
Click to reveal bullets.
Wes Douglas. A certified public accountant that recently moved to Park City. He did a consulting job for the hospital and, given his financial experience, he was chosen to be the interim (temporary) administrator of the hospital.
Dr. Emil Flagg. A physician who is a member of the board of trustees.
Helen Ingersol. A local contractor who was chosen to be on the board of trustees. While some trustees are chosen for their business skills, most do not have any experience or understanding of how hospitals work. This is evident by Helen’s comments in the board meeting.
Birdie Bankhead. Secretary to the former administrator.
David Brannan. Chairperson of the board. He is a descendant of the wealthy mining family that built the hospital. Traditionally, many community hospitals were built by wealthy local families. Many of these would continue to contribute large sums of money to these hospitals for new building projects, the purchase of new equipment, and to make up for operating losses. David was probably put on the board for this purpose. Also, he was possibly chosen for his influence with the local bank—his family is a partial owner of the bank. The hospital depends on the bank to loan it money when hospital revenues do not cover expenses.
Roger Selman. The former controller (the individual responsible for accounting). He is being blamed for the hospital’s poor financial performance and is, therefore, being fired. He is possibly being used as a scapegoat for the poor performance of the board and former administrator.

3. Wes Douglas’ First Interview
Before being offered the job as interim administrator, Wes was offered a job as a hospital consultant.
Before the interview, Wes reflects on the brief experience he had with Hap Castleton prior to his death. What was his opinion of Hap?
Click and read first bullet.
Click to reveal second bullet and read question for students to answer.
Wes was impressed with Hap’s energy and enthusiasm.
He noticed that Hap was an extrovert and enjoyed being with his employees.
Hap’s employees admired and respected Hap.
Hap was a master at hospital politics.
Hap was weak in operations; he was not as good as he should have been in the detail of operating the hospital. His popularity apparently made up for this weakness.

4. Wes Douglas’ First Interview
During his interview for the job of hospital consultant, Wes was interviewed by Edward Wycoff, chairman of the finance committee, and by Dr. Lindsey Reese, who Wycoff had invited to the dinner.
Let’s review some of the areas of hospital weakness that Reese wanted Wes to work on. (These areas dramatically impact the way nurses and doctors perform their jobs.)
Click to reveal bullets and read both bullets.

5. Areas of Weakness Quality Assurance
Quality assurance begins with the establishment of standards.
Standards include . . .
____________________
Click and read text.
Quality assurance is a program used both in industry and in healthcare to assure that the quality of products and services provided are at an acceptable level.
Click and read bullet one.
Click and read bullet two.
Nurses, doctors, physical therapists—all clinical and most administrative employees are involved in setting quality standards. Once they are established, employees are obliged to abide by them. These standards include such things as . . .
The resources (equipment, materials, personnel) that must be available to treat patients.
The training required of hospital personnel.
Systems to monitor quality.
Safeguarding of patient information.
And so on.

6. Areas of Weakness Continuous Quality Improvement Click and read text.
A popular program used to achieve high quality is known as continuous quality improvement.

7. Continuous Quality Improvement (CQI)
A BIG topic in healthcare delivery.
Every healthcare professional should understand the elements of CQI to succeed in their jobs.
In most hospitals, healthcare professionals are required to know the philosophy and terminology of this important program.
Click to reveal bullets and read text.

8. Features of Continuous Quality Improvement
Designed to improve the quality of products and services
Used in both manufacturing and in hospitals
Based on the philosophy that quality can continually be improved – it does not subscribe to the philosophy that “if something isn’t broke don't fix it”
Click to reveal bullets and read text.

9. Features of Continuous Quality Improvement
The emphasis is on future results
The philosophy believes that most problems are caused by processes and not by people
Quality is defined by exceeding the expectations of physicians and patients
Click to reveal bullets and read text.

10. Features of Continuous Quality Improvement
Uses statistical tools to uncover problems
When a problem is uncovered, the hospital administrator selects a team to identify each step in the process
The team then designs steps to correct the problems
Click to reveal bullets and read text.

11. Features of Continuous Quality Improvement
Standards are established so that future problems do not occur
A program to measure performance to determine the standards are being met is established
The steps are: plan, act, do and check
Click to reveal bullets and read text.

12. History of Continuous Quality Improvement
Continuous Quality Improvement (CQI) was first developed by an individual named W. Edwards Demming.
His objective was to improve quality while making work more fun.
Click to reveal bullets and read bullets.

13. History of Continuous Quality Improvement
Demming took CQI to the American automobile industry, who rejected it.
At that time American automobile makers dominated the world and were not interested in improving quality.
Click to reveal bullets and read text.

14. History of Continuous Quality Improvement
Demming then took it to Japan where Japanese automakers implemented it.
In the following years, the Japanese automobile industry almost put the American automobile industry out of business, based on the quality of their products.
Click to reveal bullets and read text.

15. History of Continuous Quality Improvement
Finally, American manufacturers saw that unless they improved the quality of their products, they would no longer be able to compete in global markets, and so they too adopted continuous quality improvement.
The healthcare industry subsequently adopted continuous quality improvement.
Click to reveal bullets and read text.

16. Areas of Weakness
One way of measuring the quality of care offered by a hospital is to look at morbidity and mortality.
Click and read bullet one.
Morbidity is defined as the incidence of disease, the number of times the disease occurs per 1,000 people in a population per year.
Mortality is defined as the rate of death—the number of deaths per 1,000 people in a population per year.

17. Other Areas of Weakness Identified During First Interview
HIPAA
EMTALA
Risk Management
Click and read bullets—more explanation is provided on next slides.

18. HIPPA Health Insurance Portability and Accountability Act of 1996
When was it passed?
What was its objective?
What does it do?
What information is protected?
Click bullet one. HIPPA stands for the Health Insurance Portability and Accountability Act of of It was enacted in 1996 in anticipation of national health insurance
Click bullet two. The original intent was to protect confidentiality of medical information as employees went from one job to another
Click bullet three. This act gives the right to privacy to individuals from age 12 through 18. The provider must have a signed disclosure from the affected before giving out any information on provided health care to anyone, including parents

19. HIPPA Health Insurance Portability and Accountability Act of 1996
Who is covered under the act?
What are the penalties?
Click and read bullet one.
Those covered under the act include doctors, nurses, healthcare employees, psychologists, chiropractors, hospitals and nursing homes, health insurance plans, health maintenance organizations, and government programs that pay for health care.
Click and read bullet two.
Failure to conform to the HIPAA Privacy Rule could result in either civil or criminal penalties. Penalties can be as high as $250,000 and/or prison terms of 10 years for those who sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm
Because of the federal government’s homeland security priority, the government has been fairly lax in enforcing the act as it relates to its own access to individuals protected health information (surprise!).
We will cover HIPPA in more detail later in the book.

20. EMTALA Stands for The Emergency Medical Treatment and Active Labor Act
The act is designed to prevent what is known as “patient dumping.”
Under the act, hospital emergency rooms must provide (without regard for the ability of the patient to pay) stabilization and emergency treatment when a patient presents themselves at an emergency room for emergency care.
Click and read each bullet. We will discuss EMTALA later in the book. Penalties for failure to follow the law are severe.

21. Risk Management Risk management involves:
Identifying potential risks (such as falls, infections, and so on).
Analyzing those risks
Establishing priorities for addressing those risks
Bringing resources to bear in reducing or eliminating those risks
Click and read bullets.
Risk management is a big issue for hospitals. Hundreds of thousands of patients, employees, and visitors are injured each year at hospitals in accidents that can be avoided.
We will discuss risk management in more detail in future chapters.
Suffice it to say that Brannan Community Hospital does not have a risk management program in place and it makes the facility a more dangerous place to work, and to be treated. The potential financial risks from lawsuits are also significant.
Every clinical and administrative employee has a role to play in reducing risks in the hospital.

22. Why do organizations like hospitals do the things they do?
When working in a hospital, it is useful to understand why the board or management takes the actions they do.
Without a doubt the doctors, nurses, and other employees are concerned about who will be their new administrator.
Put yourself in the place of the employees of Brannan Community Hospital. What difference does it make to you who is chosen to be the new hospital administrator?
Click and read bullet one.
Click and read bullet two.
Click and ask the question posed in bullet three. Ask the students to place themselves in the place of the employees and to tell you what questions they might ask themselves, and what concerns they might have about the selection of the new administrator. Possible answers include:
The hospital is in financial trouble. If it closes, I might lose my job. Does the new administrator have the ability to save the hospital?
I liked Hap Castleton; he was very concerned about the welfare of the employees. What if the new administrator is a “hatchet man,” (someone chosen to fire employees to reduce costs)? Will I be one of the people fired?
What changes will the new administrator make? Will he or she make my life here at the hospital better or worse?
What if I don’t like this individual, or he/she doesn’t like me?

23. Employability Skills
Every student in this room will eventually apply for a job in a career field of his choice. With all of the hiring and firing going on in the chapter, it might be a good time to talk about employability skills.

24. Employability Skills
Although he doesn’t know it, Wes Douglas is about to be interviewed for a job.
If you haven’t already, all of you will eventually face the employment interview.
What do you think all employers look for in a new employee?
Click to reveal bullet one and read text.
Click to reveal bullet two and read text.
Click to reveal bullet three and read text. Ask students this question, let them respond and then discuss some of the answers from the book on the following slides.

25. What Do Employers Look For?
Ability to do the job
Ability to get along with people
Willingness to fit the corporate culture
Integrity and loyalty
Adaptability to change
Click to reveal each bullet and read text without discussing further. We will discuss each on a future slide.
Let’s discuss each of these in a little more detail.

26. Ability To Do The Job Aptitude Education and Training Experience
Defined as the natural talent or ability to learn easily and quickly; a set of factors which can be assessed and which show what occupation a person is best suited for.
Education and Training
Experience
Click to reveal each bullet and read text without discussing further. We will discuss each on a future slide.

27. Aptitude
Different people have different skills. Individuals with strengths in one area often have weaknesses in another.
A person who is good with mechanical concepts may not be a good writer.
An individual who is excellent in math may not have good people skills.
A person who is good with people may not be good in science.
Click and read bullets.

28. Aptitude
Some people spend a great deal of time qualifying for a specific occupation, only to find they don’t enjoy the work.
They lack the aptitude for that particular job!
Click and read bullets.

29. Aptitude How does one avoid making a mistake when selecting a career?
I spent all these years going to school, but now that I’m here, I hate my job!
Click and ask question in bullet one. Solicit students discussion. Possible answers include:
Take an aptitude test.
Talk with people who work in the industry. Ask them what they do on a typical day. What is their work environment like? What kind of people must they associate with? What aspects of their job do they find enjoyable? What aspects are boring or distasteful?
Take a part-time job in the field (become a certified nurse assistant if you are interested in medicine or nursing or in a variety of other clinical positions). Observe what it is like to work in your chosen career field.
Read the literature about the job prepared by trade associations such as the American College of Pathologists.
Research the job on the internet. Find out about pay, how fast the career field is growing, what the working conditions are, and so on.
Get information on the job from your school.

30. Education and Training
Most professional healthcare jobs require some form of licensure and certification.
Professional associations such as the American Medical Association, the American Nursing Association, and the American Hospital Association can help students identify the requirements for a specific profession.
Click and read bullets.

31. Education and Training
Knowledge is expanding at an ever-increasing rate.
Much of what one learns in school will be obsolete within fifteen years of graduation.
Obsolete
Click and read bullet one.
Scientists tell us that knowledge is doubling every 10 to 15 years.
Click and read bullet two.

32. Education and Training
What, then, should a student take away from formal education?
Click and ask question in bullet one.
Most educators agree that while the acquisition of technical knowledge is important, that the most important things one can take away from a college education are (1) the ability to learn—employees rarely have the opportunity to return to school to get more education as technology advances, and (2) the ability to think.

33. Experience
Depending upon the job, some employers will require real world work experience before they hire an individual.
Internships can often satisfy this requirement.
Click and read bullets.

34. Ability To Get Along With People
Do you know that the main reason people are fired is not their lack of technical skills, but their inability to get along with people?
Click and read bullets.

35. Willingness to Fit into the Corporate Culture
What is “corporate culture?”
It is “the way we do things around here.”
The corporate culture of IBM is different from the corporate culture of Microsoft.
How?
Click and read bullet one.
Click and read bullet two.
The corporate culture at IBM was described by one as “blue or gray suit, white shirt and tie, punctuality, conservative life style. The corporate culture at Microsoft was more “sandals and t-shirt, bring your dog to work . . .”
Which corporate culture would you feel more comfortable fitting into?
Is it important to understand the corporate culture before you apply for a job at a specific company?

36. Integrity and Loyalty
What special characteristics of the healthcare industry make it important that physicians, nurses, and other healthcare employees be individuals of integrity and loyalty?
Click and read question. Possible answers include:
Healthcare employees deal with issues of life and death.
Mistakes can have greater consequences in the lives of customers (patients) then they do in the lives of customers in other industries.
Healthcare employees have access to medications that can be misused.
Patients place unusual trust in healthcare workers.
Patients are often unable to defend themselves from those that might harm them.
And so on Students will probably be able to mention many others. Encourage discussion.

37. Adaptability
What special challenges does the healthcare field face that mandate employees be able to adapt to new conditions?
Click and read bullet. Possible answers include:
Technology is continually changing. Employees must keep up to date on the latest procedures, drugs, equipment, and so on.
Technological advances bring with them new ethical issues. Examples include advances in the ability to sustain life, transplant organs, use stem cells for research, and so on.
As new ethical issues are raised, the laws adapt. Medical professionals must know the current law.

38. Adaptability to Change
New technology, global competition and changing national and world economies continually alter the way things are done.
Employees must have a commitment to lifetime learning and must be willing to adapt to an environment that is continually changing.
Click and read bullets.

39. Adaptability to Change
The only constant in the modern world of work is change.
Click and read bullet.

40. Medical Terminology
Did you know that many medical terms have Greek or Latin roots?
Students can increase their understanding of terminology by memorizing a few basic root words.
Click and read bullets.

41. Medical Terminology Learn root words on pages 42-43. Example
Nephr = kidney
itis = inflammation of
Nephritis = inflammation of the kidney
Learn root words on pages
Click and read bullets.

42. Discussion Question 1
Edward Wycoff felt that Hap Castleton and Wes Douglas would make a good team, as each would complement the strengths and weaknesses of the other.
With this in mind, discuss the relative strengths and weaknesses of Hap and Wes.
Click and read bullets. Encourage discussion. Possible answers include:
Wycoff felt that, while Hap Castleton was good with people and understood the politics of the hospital, he was poor with money and lacked a financial perspective. Wes Douglas, on the other hand, understood finance and cost control.

43. Discussion Question 2
Edward Wycoff related the story of several vice presidents of a large Fortune 500 company who were successful within the structure of that company, but lost their fortunes when they attempted to go into business for themselves.
[Continued]
Click and read bullet. (Note: story continues on the next slide.)

44. Discussion Question 2
Why did this happen, and what can an administrative person learn from this experience?
Click and read bullet.
Possible answers could include:
His friends were successful when working as a team. When they went into business for themselves, however, they chose people who were just like them. No one “has it all.” Some people have good people skills, but lack the ability to deal with money. Some are good with details, but fail to see the whole picture. A person who is going into business should select partners who are strong where they are weak.

45. Discussion Question 3
Why would a young CPA entertain an offer to serve as interim administrator of the Brannan Community Hospital?
What does Wes have to win by accepting this offer, and what might he have to lose?
Place yourself in the role of Wes Douglas. Would you accept the offer?
Click and read bullet one.
Possible answers include:
What does he have to gain? Wes obviously needs the money. His public accounting practice is not large enough to support him full-time. Serving as interim administrator would not only provide him with some temporary income, but would give him visibility in the community that might bring future customers to him.
What does he have to lose? Students might point out that if he messes up, it might hurt his reputation in the community and eventually hurt his public accounting practice. Wes probably doesn’t know much about running hospitals. Wes also has reservations about working with Edward Wycoff; it might not be a compatible working arrangement.

46. Discussion Question 4
Assuming that Roger Selman had to be fired, what do you think of Wycoff's timing?
Click and read bullet one.
Students who argue that the timing was good might point out that Wycoff has saved Wes the pain and trouble of having to fire Selman. Wes can start with a clean slate, with someone he feels is qualified to be his hospital controller.
Students who argue that the timing was poor might point out that Wes will be starting his job without anyone in the role of hospital controller. Also, Selman had some experience that he might have been able to share with Wes, had he continued in the role of controller. In addition, some employees were obviously offended by the way Selman was fired, and apparently felt that Wes had a role in his termination.

47. Discussion Question 5
It has often been said, that how someone does something is as important as what he or she does.
If you were chairman of the board, would you fire Roger Selman?
If not, why not?
If so, is there anything you would do differently?
Click and read bullet one.
Aside from the issue of timing, it appears that Wycoff used the board meeting to humiliate Selman. There was no reason to fire him publicly. If it is necessary to fire someone, it makes sense to do it in a way that will preserve that individual’s dignity. Why? (1) because everyone should be treated with dignity and respect, (2) because employees who learn how Selman was fired will have a negative perception of the board, and possibly the new administrator, and (3) maybe sometime in the future, the board or administrator will require the services of Roger Selman. Key employees who leave a hospital are often called upon at a later time to provide insight on why past decisions were made, or why things were done they way they were.

48. Discussion Question 6
While Edward Wycoff was willing to blame Roger Selman for the hospital’s financial problems, Roger felt that the board shared responsibility for the hospital’s poor financial condition.
What might the board of trustees have done to avoid the crisis described in Chapter 3?
Click and read bullets.
According to Roger Selman: (1) the board has not recognized the changes that have occurred in the healthcare industry, and has not adjusted the way it operates the hospital accordingly, (2) the board has not provided direction and control.
Roger Selman also feels that the medical staff is partly to blame. They don’t understand what it takes to run a profitable hospital, and are divided.

49. Discussion Question 7
What was the reaction of the hospital’s employees to the appointment of Wes Douglas as administrator?
What might the board have done to make the transition easier for their new administrator?
Click and read bullet one.
They apparently reacted in a hostile manner to the firing of Roger Selman, and some of that hostility rubbed off on the new administrator.
Although it has not been mentioned in the book at this point, the employees may have been surprised that they were not consulted in the hiring of a new administrator.
Click and read bullets two.

50. Discussion Question 8
As long as the board does the right thing, does it matter what the employees or the medical staff thinks?
Click and read bullet one.
One of the themes of this book is: “How one does something is often as important as what one does.” People have to be consulted, a groundwork has to be laid. “It is not enough to be right, one has to be effective.” An administrator cannot be effective if he or she does not win support for the actions he or she takes.
Yes, it matters what the employees and medical staff thinks. Without their support, the board and administrator cannot be effective.

51. Discussion Question 9
Where does real authority come from, a title, or credibility?
Click and read bullet one.
There may have been a time when a title alone conveyed authority to employees. That certainly is not the case today. A supervisor must win the respect of the employees if he or she is to be successful.

52. Discussion Question 10
What will Wes Douglas have to do to build his credibility with the board, the medical staff, and the employees?
Click and read bullet one.
This is a good time for the instructor to discuss the issue of credibility in general. What makes for a good leader? Students may reference any of the characteristics listed in Supplementary Discussion 1—Employability Skills.
Wes Douglas will have to convince the employees that he not only has their best interests at heart, but that he can identify and correct the hospital’s problems. He needs to do a great deal of listening, and must formulate and gain support for programs that will put the hospital in the black.
He may wish to distance himself from Edward Wycoff, who has an unfavorable reputation with the employees and medical staff.

53. Discussion Question 11
As long as an allied health employee has good technical skills, is it important for him or her to have good communication skills, and some political savvy?
Click and read bullet one.
We observed in Chapter One that Del Cluff’s effectiveness was hindered by his inability to communicate effectively with his supervisor, Hap Castleton. It is not enough to be technically competent, one must be able to work with people, and this involves good communication skills and an understanding of the political environment.

54. Discussion Question 12
Birdie Bankhead, Hap Castleton’s secretary, believes that Edward Wycoff may have had ulterior motives in selecting Wes Douglas to be the new hospital administrator.
What might these motives be?
Assuming that Bankhead is correct, what can Wes do to protect himself?
Click and read bullets.
When things go wrong in an organization, it is common for people to look for a scapegoat. Birdie obviously feels that the problems of the hospital are so great that they may result in the closure of the institution. The closure of a hospital can have a dire effect on a local economy. Jobs are lost, and the accessibility of patients to healthcare decreases. She suspects that, in the event of failure, Edward Wycoff might attempt to deflect the blame to Wes Douglas.
What can Wes do to protect himself? Having accepted the job of administrator, about the only thing he can do is succeed. The hospital administrator is the most visible hospital executive in the community, and, right or wrong, he will be held responsible for the survival or failure of the institution.

55. Discussion Question 13
What is the difference between a fixed price contract and a cost reimbursement contract?
Who loses money if there is a cost overrun under a fixed price contract?
Who loses under a cost reimbursement contract?
Click and read bullets.
A fixed price contract is a contract where the price of a product to be delivered is established before the product is delivered. The textbook/novel uses an example from the construction industry in illustrating fixed price contracts. If a builder agrees to build a home from a set of blueprints for $200,000, he or she must deliver the home to the customer for that price, even if the actual costs exceed that price. If the actual costs are $225,000, for example, the contractor will absorb the $25,000 loss. Under a fixed price contract, the provider of the product or service bears the risk of cost overruns.
A cost reimbursement contract is one where the price of the product is not determined until after the work is completed. If a contractor estimates that a home will cost $200,000, and it actually costs $225,000, the customer will pay $225,000. Under a cost reimbursement contract, the risk is borne by the customer.
Why is this important? Because, as we shall see, a dramatic change took place in the healthcare industry in the early 1980s. Prior to that time, hospitals and physicians delivered healthcare products under cost reimbursement contracts. Some argue that cost reimbursement provided few incentives for cost control.
With the introduction of fixed price reimbursement (more commonly called prospective reimbursement) in the 1980s, risk was shifted from the patient to the hospital, and in some situations the physician. How this occurred will be discussed in more detail later in the book.
Managed care uses fixed price contracts to encourage hospitals and physicians to control costs.

56. Discussion Question 14
Identify the root words of each of the following terms. From the roots, explain what you think the term might mean. Using a medical dictionary, write the actual definition.
cystitis
hematology
orthodontist
liposuction
ophthalmologist
pathology
tracheoscopic
gingivitis
necrosis
hypodermic
necrophobia
histology
Cystitis: Cyst = bladder; Itis = inflammation. Hence, cystitis is an inflammation of the bladder.
Orthodontist: Ortho = straight; Dent or Dont = tooth. Hence, a person who makes teeth straight. (Note to instructor: the first edition only listed the root “dent,” both roots are included in subsequent editions).
Ophthalmologist: Opthalmo = eye; Ology = study of. Hence, one who studies the eyes.
Tracheoscopic: Trache = trachea; Scope = look. Hence, an examination or look at the trachea.
Necrosis: Necro = death. Necrosis is the death of living tissues.
Necrophobia: Necro = death; phobia = fear of. Hence, the fear of death.
Hematology: Hem = blood; Ology = study of. Hence, the study of blood.
Liposuction: Lipo = fat; Suction = suction. Hence, the sucking away of fat.
Pathology: Patho = disease; Ology = study of. Hence, the study of disease.
Gingivitis: Gingiv = gums; Itis = inflammation. Hence, the inflammation of the gums.
Hypodermic: Hypo = beneath; Derm = skin. Hence, an injection under the skin.
Histology: Hist = tissue; Ology = study of. Hence, the study of the skin.

57. Discussion Question 15
Assume you are a healthcare practitioner talking to the patient of someone with no medical training about a loved one. Translate the following into “simple English.”
a. I believe your 100-year-old aunt is necrophobic.
b. The child was cyanotic at admission.
c. Your father was suffering from apnea when he called us.
d. Your son has severe gingivitis.
a. I believe your 100-year-old aunt is afraid of death.
b. The child was blue at admission.
c. Your father was suffering from a lack of breath (shortness of breath) when he called us.
d. Your son has a severe inflammation of his gums.

58. Discussion Question 16
Roger Selman argued that it was justifiable to sign a contract with the Mountainlands Insurance Company at a price that was lower than hospital cost to maintain its volume of patients.
Do you believe this was an appropriate decision?
Click to reveal bullets. Read text.
Arguments in favor of Roger’s logic: If the hospital loses the contract, revenues will decrease. Some costs (i.e. fixed costs like insurance, maintenance etc.) will not decrease. Revenues will decrease more than costs and the hospital will loose money.
Arguments against Roger’s logic: In the long run, revenues must equal costs, or the hospital will lose money.
Sometimes an organization like the hospital may accept a contract at a loss to keep from losing a valued customer, believing that prices or revenues can be increased in the long run.

59. Discussion Question 17
Consider the way Edward Wycoff leads his board and staff.
Does he have the attributes of a successful long-term leader? Why or why not?
Click and read bullets.
This is a good place to discuss the attributes of effective leaders. Good leaders must win the minds and hearts of their followers. It does not appear that he has been successful in doing this. Perhaps he is more of a dictator than a leader.
If students have held part time jobs, have them discuss the leadership styles of their bosses. What leadership style do they intend to develop?

60. Discussion Question 18
What made Wes Douglas successful in his communication with Birdie Bankhead in this chapter?
Click and read bullets.
The breakthrough appears to have occurred when Wes placed the needs of the Castleton family above his own. With regard to the removal of Hap Castleton’s personal items from the office, Wes said: “There’s no hurry. Let the family do it at their convenience.”
Consideration begets consideration. Have the students discuss the impact of “little things” on the way that employees are perceived.

61. Writing Exercise 19
Assume that you are in the role of Edward Wycoff as he fires Roger Selman. Using the reasons given in the chapter, prepare a script of the conversation you would have as you let Roger know that he was being terminated. Demonstrate kindness, understanding and courtesy in place of the tactics Wycoff used.
Student Presentation

62. Writing Exercise 20
Using the tools taught in Supplementary Discussion 1—Employability Skills, develop a plan to explore a specific health care career. Consider: (a) personal aptitudes, (b) education and training requirements, (c) pay and employment opportunities, and (d) work environment.

63. Role Playing 21
Select a team of six or more people to role-play the board of trustees of Brannan Community Hospital and the administrator before the class. Have the board develop a plan to save the hospital in the next 30 days. Address the following problems:
1) the hospital is not generating enough cash to pay its bills.
2) employee morale is at an all-time low.

64. Role Playing 21 (cont.)
3) the newspaper is running unfavorable editorials about the operations of the hospital.
4) the community is losing confidence in the quality of services provided by the hospital.
5) there is talk of an initiative to close the hospital down.

65. The End!