Rittenhouse Medical Corporation

3. What are the possible sources of conflict between the two models of care? How might they be reduced?

Possible sources of conflict between the two models are as follows:

• Objectives of the models: While the sole objective of 3B Ortho is profitability which can be achieved through efficiency in replacement procedures, the objectives of the faculty included contributing towards teaching and research. The overall commitment of RMC to training new physicians and other medical professionals apart from provision of free care to indigent patients.

• Flexibility of Doctors: Though neither of the groups reported to Wilson, the 3B surgeons had more flexibility compared to Faculty practice surgeons to switch hospitals as they had no responsibilities towards RMC.

• Sharing of common resources: Both the groups shared a common pool of resources such as operating rooms, operating room staff, central supply and anaesthesiologists. While 3B focused on gaining access to dedicated resources (OR staff and anaesthesiologists) for the standardized processes, these dedicated resources were not exclusive to 3B procedures. This results in work pressure on dedicated resources and tension among the common resources.

• Standards and Procedures: 3B surgeons focused on implementing standardizing everything from suppliers to which tool comes after what in the operating room. On the other hand, the Faculty surgeons were open to variety as this gave them more options to test and research. Even the variety of procedures undertaken by the faculty surgeons helped them in their overall objective which did not directly show in their financial results.

Taking input from “The Focused Factory” article, some ways to reduce these conflicts could be:

• Setting clear and distinct objectives: The objectives of profitability must be met along with other commitments. Net patient revenue forms a substantial portion of RMC’s revenue, but the non-patient revenue from research and training are increasing year-on-year accounting for ~12% in 2006. The Faculty surgeons must be given clear targets of increasing the non-patient revenue at a healthier pace.

• Communicating objectives across both models: Since the source of conflict would be due to sharing of common resources, the objectives of both models should be clearly communicated to everyone involved. This will help reduce the political tensions among the staff as well as surgeons.

• Clear rules for sharing: Once the terms of sharing the resources (instruments and staff) is clear, it becomes easier to plan for the low variety high volume procedures. This was already taken care of in the case of RMC

• Exploiting positive spill-overs: The best practices of ‘as efficient as possible’ followed by 3B Ortho such as tool rationalization and sequencing, being effective and efficient can be understood and adopted by faculty surgeons while conducting the typical replacements. The knowledge gained through the research of Faculty surgeons could be shared with the 3B Surgeons who can utilize this input to further improve efficiency and quality of care in the high-volume procedures.

4. Should Neela Wilson accede to Dr.Booth’s request? If not, how should she respond?

Neela