Summary of Findings

The Professor felt ill and decided to go home but during the drive he experienced discomfort and in the succeeding hours experienced severe diarrhea and persistent nausea and vomiting. Eventually the nausea ceased but his stomach was still upset. The following day he called Dr. Martin, his primary health care physician. Betty, the doctor’s nurse assisted him over the phone and after the professor explained his condition she told him that Dr. Martin cannot see to him because of his packed schedule. The professor asked for a referral to go to the HealthCheck Clinic but the nurse declined claiming that Dr. Martin is not willing to send him there and was instead prescribed with medicine for the diarrhea. The prescription was placed in the pharmacy for the professor to pick up. Unsatisfied, the professor called up Candy, the director of the Employee Benefits Office, but Wendy picked up and relayed everything to Candy who then expressed her surprise and distress over the situation. She too did not understand that the request for a referral was denied as the professor asked for it.

The professor picked up the medicine from the pharmacy, drove home, took a pill, and went to bed. The following day the diarrhea was under control but the gastric discomfort was still a problem. He decided to go to work but in the afternoon he gave up and went home. He called Dr. Martin’s office and once again Betty answered the phone. She informed him that the doctor is out all afternoon and still claimed that the doctor refuses to refer him to HealthCheck. Betty believed that Dr. Martin would want the professor to go to the emergency room. Beyond irritated, the professor decided to go to HealthCheck himself without a referral to figure out what was wrong with him. Almost immediately after explaining to the reception all that has happened and how he felt, he was brought into a treatment room where he was examined by Hilda, a nurse practitioner, who he had seen before. She decided that a blood sample was to be drawn and tested on site and within half an hour it was concluded that the professor had contracted a virus and needed to be checked for internal bleeding. He was prescribed medicine and was sent home as the nurse informed him that he was contagious. His wife picked up the prescription while the professor went home. When she arrived he took the medicine and within an hour noticed an improvement and later on he felt normal again.

The next day he called Betty and told her that he has recovered and was still curious as to why he wasn’t given a referral. Betty told him that the doctor felt that he wouldn’t get the best care from HealthCheck. Furthermore, the professor asked her if the doctor will not refer him in order for his insurance to pay the bill. Betty said that he will check with the doctor but doubted that he would give the referral. He then called Wendy and brought her up to speed to inform Candy.

Background Information

HealthCheck
It is much less expensive than going to the hospital emergency room in order for the professor to be diagnosed and treated. Dr. Martin is on the staff of the hospital which owns HealthCheck. The clinic is two miles away from the professor’s house, which isn’t that far. They have the necessary equipment to run blood samples so that the results are received as soon as possible in order for a diagnosis to be made and a treatment or medicine to be dispensed.

Dr. Martin’s office
For most of the case Dr. Martin is always busy or out of the office and cannot see the professor. Betty, his nurse, is the one that answers the calls. Dr. Martin is on the staff of the hospital that own the HealthCheck clinic. It is still unclear what the behind reason for the refusal of the referral is as the only reason provided was that the doctor did not believe that the professor would get the best treatment from HealthCheck. There is no supporting evidence as to why Dr. Martin would think that is the case. Dr. Martin is an approved primary provider with the University’s health plan.

University Employee Benefits Office
The office is headed by Candy who is assisted by Wendy. It is stated in the case that there were changes in the University’s health care plan in order to cut costs and that going to HealthCheck is cheaper than going to the hospital’s emergency room. The plan of the University is self-insured and faculty and staff ultimately pay all the bills.

Problem Statement

With the lack of coordination between the University’s health care plan and their health care providers, this could cause more disruptions in giving their services. Is there a way to prevent creating problems similar to the one the Professor faced?

Analysis of Alternatives Close Monitoring
Performance Metrics
Contracts and Agreements
Advantage
Can immediately confront/deal with mistakes and errors
Driving force for improvement
Can keep employees safe and manage employee behavior

Advantage
Can establish systematic customer and work relationship
Rewarding system can raise employee commitment
Evaluation may be documented

Advantage
Strong bond of company and employees (Work Relationship)
Employees follow agreements

Disadvantage
Can cause distrust and resentment
Might ruin right of privacy

Disadvantage
Time and cost consuming
Evaluators might be biased

Disadvantage
The company is under pressure of legal liability
Low flexibility of employee arrangement
Difficult to negotiate

First alternative is establishment of close workforce monitoring that employers can immediately and directly deal with the mistakes and errors committed by employees that will provide driving force of improvement. It also allows managers to keep their employees safe and manage them to behave. However, workforce monitoring system may cause distrust and resentment of employees because of employees’ pressure of being monitored and observed by others. There is a possibility of abusing privacy of employees. Second alternative is constructing employee performance evaluation metrics which can bring firm customer and employee relationship. Evaluation feedbacks of employees from customers will be documented and offer standard for performance rewarding system which aims to recognize employee achievement. However, there is a possibility of evaluators being biased and dishonest customer might ruin the system. Making evaluation standard and structuring of rewarding system will be time and cost consuming.
Last alternative is making employee contracts and agreements. This will bring legal responsibility of two parties, the company and employees that will cause strong bond of work relationship. But legal responsibility can mean legal liability and pressure on both parties that are bound to strict and formal articles under contract and law.

Detailed Recommendation

The action taken by the Dr. Martin and his nurse assistant, Betty could have led to death of the professor. In order to prevent same or similar situation from happening, the proponents have chosen to implement employee performance evaluation system. Among three alternatives, it is the most systematic way of evaluating employee performance and build strong customer relationship and work relationship of employees. The evaluation will be done by customers and those feedbacks will provide foundation for improvement of employee performances. With rewarding system, employees can be recognized and rewarded based on their performances and other employees can be encouraged to excel efforts in their tasks. Furthermore, the rewarding system can set a certain standard that employees can follow and base their morale.

Furthermore, they should find out why the doctor refused to give a referral and implement performance metrics in order to track whether or not the new care plan is being implemented and their goal of cutting costs is being reached. The criteria can be recognized by implementing performance metrics such as evaluation system, rewarding system and etc.

Answers to Case Questions

Who is the customer in this case?

The customer in this case is the professor who experienced severe diarrhea and recurring waves of nausea and vomiting. Also, the professor’ wife who picked up his medicine at the pharmacy and has always gotten good service at HealthCheck with the professor.

Describe the supply chain of this health care delivery system. Also, identify the roles of the primary players. Referral
Admitting/attending
Hospital
Patient

In this study, admitting physicians are considered as suppliers in a traditional supply chain sense, as they refer patients to hospitals as well as provide services to patients while in the hospital. The hospital is considered as the focal firm where care and service are coordinated and provided to patients. Lastly, the patients are the ultimate customer of the healthcare delivery supply chain.

Dr.Martin - The professor’ primary care physician
Betty - Dr. Martin’s nurse
Wendy - The assistant director of staff benefits
Candy - The director of the Employee Benefits Office Hilda - A nurse practitioner at healthcheck clinic The professor - Patient Wife - Picked up the medicine at the pharmacy for the professor

Knowing who the customer is, and considering present customer service levels, what are the implications for supply chain redesign and for optimization of good customer service while keeping costs in check?

Preventing serious illness which could have led to death of the professor is in need of collaboration amongst supply chains. Simply put, supply chain management in the hospital or in industry should be aligned. Firstly, Dr Martin’s nurse, Betty, did not allow the professor to get a diagnosis or see a doctor. Not even giving an explanation that's valid is unethical. It is recommended that Betty improves her communication skills, encourages herself to accommodate the professor properly, and her wrongdoing. Such dissatisfaction requires upper managers or HR managers to find new ways to balance the situation, while ensuring good systematic customer and work relationship. The evaluation and rewarding system make it possible for the managers to raise employee commitment. The performance metrics also enables them not only to avert customers’ dissatisfaction but also to promote organizational level which can systematically lead to integrate with other functional areas. Performance metrics among supply chains in order to track whether or not the new care plan should be implemented and their goal of cutting costs is being reached

Discuss the ethical issues involved in the doctor’s refusal of referral to the HealthCheck clinic.

Doctors should know the current situation of their patients. Before doctors give prescription for medicine, they need to check and consider their patient’s health condition. Ethical issues involve the wellness of the patient and proper procedure. However, doctor Martin didn’t provide medical service to his customer. Doctors should respond to their patients’ requests but Dr. Martin didn’t. Dr. Martin even didn’t give an explanation why he refuse to see his patient. What happened could have led to death of the professor. Personal feelings should not be taken into account because lives are involved in this case.

Learnings

In this case, we could learn that there is supply chain in medical industry. Additionally, we could learn there should be enough communication between the supplier and the customer. There should have been coordination between the University’s health care plan and their health care providers in this case. Through this case study, we were able to come up with alternatives and we learned how to cope with such a situation.

Moreover, we learned the importance of communication between the suppliers and customers since without communication it is hard to keep their relationship. Also, especially for the medical industry, it is critical problem, which is refusal, since the industry is dealing with the lives of people. Ethical issue is risen in this industry.