Case study – carla
Case Study 1
Carla graduated from her medical assisting program just over a year ago. After considering three job offers, she decided to work in a small practice owned by three familymedicine doctors. One of the doctors isnearing retirement age, another has 10 yearsof experience, and the third just completedhis medical residency program about twoyears ago.
Things were going just fine until lastweek when the practice manager and doctors announced that changes on are theway. They said they need to find ways tocare for more patients, especially those coveredby Medicare. They want to prepare forthe impact of health care reform, adjust tochanges in health insurance, replace outdatedequipment, remodel the waiting areaand exam rooms, employ a physician assistantand another nurse practitioner, andhave more control over their income andexpenses to remain competitive and financiallysound. They said that, after a greatdeal of thought, they’ve decided to give uptheir private practice and join a network.
Within six months, the name of the practicewill change and the employees, includingCarla, will be working for the network company.Patient medical records, currently stored in paper files, will be transferred to EMRs (electronic medical records.) Doctors and staff will undergo training to use sophisticated computer software to store medical histories, physical exam information, and treatment notes; order blood tests, x-rays, and other procedures; locate and evaluate test results; send prescriptions to the pharmacy; and provide immediate access to complete, up-to-date medical information when their patients receive services in other locations.
What do these changes mean for Carla? She chose this practice because of its small size and relatively low-stress environment. She has basic computer skills but is worried about having to master new technology. She can‘t help but wonder if these changes are really necessary. Carla‘s former classmate, who works at another nearby medical practice, said they have an opening for a medical assistant (MA) and nothing has been said in her practice about joining a network or switching to EMRs. Should Carla stay or look for another job? If she decides to stay, what could she do to prepare for the changes? Could she help her doctors, manager, and coworkers make the transition? What might happen if she leaves?What would you do if you were Carla?
Case Study 2
It’s been just over a year since Carla decided to stick with her job and she’s glad she did. Joining a network turned out to be a positive change for everyone including the employees, doctors, and patients. Switching to electronic medical records was quite a challenge but the benefits are now obvious. Although Carla was nervous about having to learn some new computer skills, she sailed through the training and even helped her coworkers and the doctors complete theirs. With renewed confidence in her ability to learn new things, Carla is seriously considering enrolling in a bachelor’s degree program at a local university using the tuition assistance benefit she gained when her employer joined the network. Now it’s time for Carla to undergo her first performance evaluation. She hasn’t been late or missed a day of work since she started. She has a positive attitude, submits suggestions for improvement, and always speaks highly of her employer in public. She complies with policies and rules, accepts responsibility, and holds herself personally accountable for the quality of her work. The doctors and her manager have made lots of positive comments about her performance but Carla realizes she’s in the early stages of her career and still has more to learn. What can Carla do to prepare for her first performance evaluation? How can she find out what criteria will be used and how her performance will be scored? What materials could she gather to demonstrate the quality of her work and the impact she has made during the year? Should she mention that she joined a professional association and attended continuing education seminars every quarter? Should she bring up the fact that she’s thinking about returning to school to work on an advanced degree? What would you do to prepare for your performance evaluation if you were in Carla’s place?
Case Study 3
It‘s been almost four months since Carla underwent her first annual performance review. Positive feedback from the doctors and her office manager and coworkers resulted in an outstanding evaluation. Carla received the highest score that the practice has ever given to a new medical assistant with just one year of experience.
She received a modest pay raise and spent part of her next paycheck on the textbook that‘s required for the college course she just enrolled in. Things were going really well until last week when Carla overheard one of the network‘s purchasing agents on the telephone with a salesperson from a localcomputer company. Carla heard the purchasingagent tell the salesperson that shewould buy 100 computers for the networkif the salesperson would agree to give herhusband the same quantity discount forthe five new computers he needs for theirfamily-owned grocery.
At first, Carla didn‘t pay much attentionbut the more she thought about it, sherealized that what the purchasing agentwas doing wasn‘t right. She was using herauthority as her company’s purchasing agentfor her own personal gain and that seemedlike a conflict of interest to Carla. Now shecan‘t decide what she should do, if anything.She‘s still relatively new, really likes her job,and doesn‘t want to cause trouble but shecan‘t help but wonder what other dishonestacts the purchasing agent might be involvedin. If someone finds out that she suspectedthe purchasing agent of unethical behaviorbut didn‘t report it, Carla‘s afraid that shemight get in trouble, too.What, if anything, should Carla do?Should she mind her own business andremain quiet? Or should she report thematter to a superior, confront the purchasingagent about the conflict of interest, or takesome other action? What would you do ifyou were in Carla‘s place?
Case Study 4
It‘s been 6 weeks since Carla decided to report what she believed to be a conflict of interest on the part of the network‘s purchasing agent. And she‘s glad she did. An investigation uncovered several instances of dishonest behavior and the purchasing agent was fired. The network‘s director and Carla‘s practice manager thanked her for being attentive and willing to step up and report the wrongdoing of another employee. They told Carla they really appreciated what she had done to protect the reputation of the company and they said they wished other employees had a similar sense of loyalty and commitment.
Carla isn‘t sure if there‘s a connection to this whistle-blowing incident or not but she‘s just received a special assignment and a pay raise to go with it. She‘s now assigned to a brand new interdisciplinary team that‘s been formed to design and open a new clinic across town. Several coworkers have congratulated her and she suspects they‘re surprised that a relatively new MA could earn such an impressive assignment so quickly. But everyone seems to like Carla and she‘s been told she has great people skills, so she‘s happy about the change and looking forward to her new role.
But Carla‘s enthusiasm took a nosedive at the first team meeting. People were pulled from several different practices in the network to create the new team, so members were meeting each other for the first time. It became clear quickly that people had a lot of different opinions to share, which didn‘t surprise Carla. She had worked in health care long enough to know that nurses, medical assistants, physician assistants, office personnel, and doctors would have different perspectives and couldn‘t be expected to agree on everything, but the first meeting was chaotic. Several people tried to talk at the same time while others remained silent.
No one was put in charge, so when three people tried to take the lead, conflict broke out. Some of the team members weren‘t very polite. They laughed at people‘s ideas and interrupted when others were trying to speak. One man became aggressive and left the meeting early.
Now Carla is worried. Her job depends on the team‘s success but some of the members don‘t seem up to the challenge. What should Carla do? Should she ask to be removed from the team, go back to her old job, and give up her raise? Should she take over leadership of the team and tell people to shape up? Is there something Carla could do to help the team function more effectively? What would you do if you were in Carla‘s place?
Case Study 5
Carla was disappointed in how poorly her new team functioned during its first meetingso she found some books and otherreference material on group dynamics,meeting facilitation, negotiation, and conflictresolution. When the team met for thesecond time, she wasn’t the only memberwho voiced concerns about the need towork together more effectively. Carla hadread about the concept of group norms andthought it made sense. She suggested thather teammates develop some group normsto serve as guidelines as they moved forward.
Other people liked the idea and afterabout 30 minutes of discussion their “rules”were posted on the conference room wallfor everyone to see and follow.Carla was pleased that people liked hersuggestion and relieved that the group wasmoving along more smoothly now. Severalsub-committees had been formed to coordinatea series of projects. Over time, it wasbecoming apparent that Carla was emergingas a leader of her team. She realized that,with practice, she was getting pretty good atfacilitating the meetings. She made sure thateveryone’s voice was heard and their opinionswere respected. She worked hard to improveher communication skills and develop strongerorganizational and time management skills.
Carla’s supervisor was very pleased withher performance as were other leaders in thenetwork. As a result, Carla was appointedteam leader of the new Patient Experiencesub-committee created to figure out whatit would take to deliver first-class customerservice in the new clinic still under construction.Carla was thrilled and nervous at thesame time. In addition to her current job,she had only worked in one other place andthat was the small practice where she didher practicum. With only limited patient careexperience, she had no idea where to beginin coming up with a plan to provide the bestpatient care experience of any clinic in town.What should Carla do? What would youdo if you were in Carla’s place?
Case Study 6
It‘s been several months since Carla startedworking with her new team and she‘s realizedthat things have really changed withher job. As part of her duties as team leaderfor the Patient Experience sub-committee,she‘s been visiting several out-of-town clinicsknown for their outstanding customerservice and high patient satisfaction scores.
She‘s read dozens of articles and reportsabout customer service in 5-star restaurantsand hotels and thought about how theirapproaches might apply in health care. She‘sconvened two focus groups of patients toask them what they feel is important whenreceiving clinic-based services. She‘s learningfar more than she ever expected in sucha short period of time. And she‘s really gladthat she still gets to work as a medical assistantabout 20 hours a week to maintain herskills and contact with patients.
Carla‘s role has changed dramatically.She‘s out in front now, meeting with doctors,conversing with patients, negotiatingwith vendors, and giving reports at staffmeetings. Her hard work has certainly paidoff but now she‘s beginning to wonder if herpersonal image needs some sprucing up. Sheisn‘t used to giving presentations and participatingin high-level meetings but she knowsshe has to look the part. She‘s beginning towonder if she should lose some weight, getin better shape, and buy some clothes otherthan scrubs.
What should Carla do, if anything, tomake sure that her appearance and her overallpersonal image support the success she‘s experienced in her new role? What, if anything,would you do if you were in Carla‘splace?
