Power and Influence
Southglenn Physical Therapy Clinics Case Study
Lawanda Hastings has a challenge ahead of her. She recently took over leadership responsibilities for the downtown branch of Southglenn Physical Therapy Clinics (SPTC), which are private outpatient clinics owned by Dr. Matt Nelson. SPTC has served the Salt Lake City community since 1999 and specializes in orthopedic rehabilitation, sports medicine, deep tissue massage therapy, aquatic therapy, and work-related injuries. Over the years, Dr. Nelson has built SPTC from a single outpatient clinic to three complementary clinics that have a sound reputation for providing excellent physical therapy services.
SPTC is especially well-known for the excellent rehabilitation services provided for professional and amateur athletes who injure knees or other joints in snow sport accidents, common injuries associated with Utah’s exceptional ski resorts, where many collegiate and Olympic athletes practice for competitive events, and families ski and snowboard during the winter months.
The three clinics complement one another because each offers basic rehabilitation services, and each is also known for a particular specialty. For example, the Main SPTC clinic, now housed in a 30,000-square foot building with an indoor pool, focuses on sports medicine, athletic injuries, and aquatic therapy. The Downtown clinic that Lawanda now leads specializes in work injury programs, designed to help patients return to full employment after an occupational injury. The smallest of the three clinics in the nearby suburb of Murray primarily treats post-surgical patients to help reduce pain and increase mobility. All three clinics are located along the light rail line, making travel between the clinic locations for staff and patients quite easy.
Clinic Roles
Each of the three SPTC operations is headed by a clinic director, whose role is to lead clinic operations and coordinate patient care at the clinic location. Each director is also a licensed physical therapist, who ultimately oversees the professional conduct of clinic staff. The three directors report directly to Matt Nelson, as does the clinic administrator, who is responsible for functions such as patient scheduling, client and insurance billing, the electronic medical record system, purchasing and accounts payable, and personnel and payroll services. These functions are coordinated centrally at the Main SPTC clinic, as are out-sourced custodial and maintenance services for each clinic.
A marketing coordinator also reports directly to Matt. About 65% of the patients seen at SPTC are referred by local physicians, so maintaining strong relationships with local medical providers is essential for SPTC’s long-term prosperity. Along with Matt, the three clinic directors, the clinic administrator, and the marketing coordinator comprise the SPTC leadership team. Additionally, at each clinic, managers oversee the clinic’s routine physical therapy services and rehabilitation services, and directly supervise the work of the physical therapists, occupational therapists, massage therapists, and athletic trainers employed at each clinic.
Lawanda was the clinic director at the Murray clinic for four years and successfully oversaw growth of the clinic’s surgical rehabilitation practice. Then, abruptly, the clinic director at the Downtown clinic left under a cloud of suspicion that involved sexual harassment claims against him by two of the female massage therapists. Matt asked Lawanda to take over leadership responsibilities for the Downtown clinic and to address leadership and managerial needs of the understandably dispirited staff.
Just the Facts
Through discussions with Matt, interviews with the four departmental managers who now report to her, and open forum dialogues with clinic staff, Lawanda has discovered the following:
Client feedback surveys have shown a downward trend in patient satisfaction with service provided at the Downtown clinic. The biggest concerns come from patients using the occupational therapy department, which represents the largest number of patient service interactions for the clinic. Patient concerns include difficulty scheduling appointments, late appointments, and impolite staff who rush them through their treatment. Patients who rated other clinic services at the Downtown clinic such as physical therapy, massage therapy, and athletic training didn’t identify the same concerns with staff interactions, but they also pointed to difficulty scheduling appointments at the clinic.
A recent staff survey suggests that Downtown clinic staff enjoy the work they do, but feel pressured to hurry through appointments because of tight schedules. They also reported concerns about relationships with their managers, including some managers who reportedly micro-manage their staff, and other managers who are largely unavailable to help out when needed. Over the past year, the Downtown clinic has hired several new staff members in the physical, massage, and occupational therapy departments, and dissatisfaction among staff is disproportionately higher among newer hires.
The manager of physical therapy has been out on maternity leave and subsequently decided not to return to her job. The previous clinic director narrowed the number of applicants to replace the manager to three individuals. One of the final candidates is a physical therapist at the clinic who has been acting as the interim manager while the previous manager was away from her job. A final decision needs to be made on the candidate to fill this important managerial position.
The allegations of sexual harassment against the previous clinic director are common knowledge among clinic staff, even though the investigation of the allegations is being handled confidentially by an outside HR consulting team. Everyone in the clinic seems to have an opinion about what happened and who is to blame, which has led to tensions and hostilities between colleagues. Some hold the former clinic director accountable, and others are loyal to the previous director and believe the allegations are unfounded. Clinic managers have not been able to curtail the gossip, even though they have tried, which has led to mistrust of colleagues and leadership, skepticism about whether employees are valued, and negative attitudes and behaviors among the staff. Motivation seems to be quite low.
Although the Downtown clinic is stable financially (as is the entire SPTC organization), there have been accusations of financial malfeasance or impropriety in the use of clinic supplies and equipment for personal benefit. Employees may use clinic facilities for personal fitness and treatments, such as using the whirlpool, or using athletic training equipment to work out before or after work, and then showering in the small changing area of the gym. However, some of the therapists have been providing therapeutic services for family and friends outside clinic hours but using clinic facilities. The previous clinic director did so himself and turned a blind eye to this practice among other staff, even though the employee handbook stipulates that clinic facilities and supplies are not to be used to provide services to individuals who are not actual patients at the clinic.
All healthcare service providers nationwide have been mandated by the U. S. Department of Health and Human Services (HSS) to convert paper medical record systems to electronic format. Failure to do so will affect provider Medicare reimbursement. The SPTC clinics are in the process of converting their medical record system to electronic format, but not without some difficulty. Staff have been resistant to the change, and progress has been slower than desired because of challenges working with the consulting firm helping to implement the conversion. Each clinic director is responsible for training staff to begin to use the new system, but the previous clinic director of the Downtown clinic had made little progress in developing a plan to manage the conversion prior to his departure from the clinic. Staff are still using paper records because they haven’t been trained to use the new system, and concerns about the ramifications of failing to comply with HSS directives are mounting.
In a paper of at least 2,400 words (exclusive of title, abstract, and reference pages), and referencing at least six scholarly sources in addition to required readings, apply your learning from throughout the class to address the following:
Identify a leadership model that has been discussed in class (Transformational Leadership, Authentic Leadership, or Servant Leadership) that you believe would be an effective approach for Lawanda to follow as she begins her work in the clinic.
Discuss how and why this leadership model will enable Lawanda to be successful in her new role.
Lawanda must choose among a group of candidates to fill the managerial position vacated by the manager of physical therapy. Referring to the models of managerial skills, responsibilities, and behaviors you have studied in this course,
Identify the skills and competencies Lawanda should look for in a managerial candidate.
Discuss the roles and responsibilities the new manager must be able to demonstrate in overseeing the work of a group of staff.
Note that you do not have to include specifics of managing a physical therapy department; instead, focus on the general managerial roles and responsibilities the new manager would be expected to perform.
In selecting the new manager of physical therapy, Lawanda can make a solo decision, or she can involve others in the organization in a group decision-making process.
Analyze the options for Lawanda.
Recommend a path forward that will best serve the organization,
Defend your recommendations based on the literature.
The current situation within the Downtown clinic suggests a lack of trust among employees for leaders and managers.
Analyze how Lawanda and the managers who report to her (the clinic leadership team) can influence organizational culture and values to improve the situation that is described in the case study.
Provide specific examples of actions that can be taken by the clinic leadership team to influence organizational culture and to regain the trust and respect of employees.
Lawanda must work with the clinic managers to develop a plan for transitioning staff from a paper-based medical record system to an electronic medical records system.
Using one of the change management models you studied in this course,
Recommend a path forward for the clinic leadership team in effecting the training and procedural changes that will be necessary to transition to the new electronic medical records system.
Note that you do not have to identify specifics of a training plan nor the specifics of procedural changes. Instead, focus your response on the application of a change management model and how the clinic leadership team might support the required steps in supporting change efforts.
The Downtown clinic leadership team has some work to do to get the clinic back on track and operating smoothly and successfully.
Provide advice to the clinic leadership team on how to influence the motivation of employees within the Downtown clinic.
Assess the specific motivational factors that can be employed to establish a more motivating environment within the clinic, citing contemporary literature.
