Leadership Decision-Making - Mafraq Hospital - Case Study Example

Running Head: Case Study Case Study Leadership Decision Making [Pick the Table of Contents The Organization 2 2.Important Personnel 3 3.Outside Environment 6 4.The Problems and Need for Decisions 7 5.Questions 15 References 17 1. The Organization UAE has faced substantial development in all its business and social sectors, especially the medical sector and healthcare facilities provided to its citizens. My organization for the case study is the government hospital “Mafraq Hospital” in UAE under Abu Dhabi Health Services Company (SEHA). SEHA HealthSystem and is owned and operated by Abu Dhabi Health Services Company PJSC (SEHA) which is responsible for the curative activities of the public hospitals and clinics of the Emirate of Abu Dhabi. The hospital is a tertiary hospital and serves all cities in UAE, operational for nearly three decades it is one of the most known basic healthcare institution in the country. There are some major problems existing in the organization I am working for and in my opinion there is a need for a drastic change. The management of most common areas that makes an institution a success are lacking. Being a pioneer in medical research, training of future professionals and world class quality patient care, the hospital and its employees deserve implementation of the best practices from the management that can keep them motivated and geared up for future challenges (Marfraq, 2013). The hospital is a part of public joint stock company with a diversified workforce consisting of 2038 employees belonging to 54 different nationalities, it claims that the prevailing culture is professional, caring and respectful with team work at its core. The mission and vision of the hospital seeks establish itself as a healthcare provider of choice for its patients, employees and physicians. Marfraq, an Arabic word means “joining of roads”, as it is located at an intersection of main roads, 35 kilometres southeast of UAE capital, Abu Dhabi. The hospital was established in 1983 and since than it has come a long way with a capacity of 451 beds providing major medical and care services (SEHA, 2008). The hospital will move to a new and improved infrastructure in 2014 with state of the art medical equipment and an additional staff requirement of about 30 – 35% (SEHA, 2008). 2. Important Personnel The five key employees that occupy the decision making positions in the hospital are: • Mr. Amin khaled, MD (CMO) He is the chief medical officer with the most decision making powers. He is 50 years old and he has been associated with the organization since its inception. He is a disciplinarian and an old school doctor who believes in confinement and superiority of the medical field over others. An Emirati national who comes from a well-connected family with a bureaucratic communication style and believe in centralization, gender discrimination and strictly work relationships. He does not believe in cross functional teams, extensive rights and autonomy given to the employees. Mr. Amin believes in Emiratization and prefers lesser skilled UAE nationals over other nationalities. Furthermore his management style discourages job recognition, state of the art HR policies/procedures and HRMIS (human resource management information systems) along with reward distribution based on good performance etc. • Mr. Richard Afate, MD (CEO) He is the chief executive officer of the establishment and his role is secondary after Dr. Amin. He is known to possess modern knowledge of management although his position was created recently. He has master of healthcare administration and he has been with the hospital for about 1 year. Richard possess valuable experiences in modern age medical institutions with impressive leadership and management skills. His communication style is direct and open with empathy shown towards employees and other stakeholders. He hails from Netherland and has a pleasant personality. Richard has good command over English but no knowledge or understanding of Arabic language. This sometimes becomes a hurdle for him and his communication to Arabic people is limited. From his experience Richard has learned that hospitals cannot work in isolation and that various fields of science and management must combine together. This combination makes a medical institution a truly great entity with satisfied employees, increase in patients resulting in a healthier and happier society. He believes that using modern age marketing, human resources and information technology tools and techniques, the institution can be brought to par with any western healthcare provider. His journey to Marfraq and prevailing situation has not been an easy one, his initial assessment and proposals were shot down by Mr. Amin who back than told him to slow down and try to learn the Emirati way and prevailing the culture of Marfraq. As Richard started to mingle with employees and using his charisma many started looking up to him, this created a divide in the workforce as many employees started voicing their opinion in favour of Richard while others supported the old school methods of Amin. Richard became an instant hit with non-Arabic employees as his personality suited to other nationals. His approach towards recruitment is based on merit with a goal to bring drastic changes to the hospital’s major problem areas. Another unrivalled strength carried by Mr. Richard is his multicultural and multidiscipline approach with commitment to lifelong learning and teaching. Using his approach changes for good can be brought in Marfraq although a strong resistance is expected by Mr. Amin and his sympathizers. • Mr. James Gaus, MD (Head of Surgery) James is the head of surgeries and emergency departments. He possesses an introvert personality and has no say in decision making. He is a caring person and takes his own work and profession seriously. He has been associated with the hospital for nearly two decades and his contribution is only towards development of medical practices and patients’ wellbeing. • Mr. Omar Salem, MD (Head of QA) He is the head of quality assurance and facilities. He is an honest, creative person and he supports Mr. Richard. He has good relationships with his colleagues and supervisors. His role is restricted to management of facilities and quality improvement initiatives in maintaining customer satisfaction and patient services. • Mr. Abdullah Essa, MD (Head of R&D) He is the head of research and development with 8 years’ experience. He is 39 years old and has been associated with the hospital since its inception. His key responsibilities are related to research and development of diseases and new medical practices. He executes work successfully since he has a high level of concentration. 3. Outside Environment The government wants to improve the current scenario at the facility, bringing it on par with western healthcare institutions. The patients prove to be the major stakeholders of the institution and they seem satisfied with the services. The hospital maintains minimum standards set by regulatory bodies and medical associations although the services provided by private medical institutions and western hospitals are far more efficient and courteous. The hospital has a reputation of being extremely bureaucratic hence most qualified and distinguished doctors, surgeons and specialists do not prefer it as a first choice employer. The most important outside element is the UAE government agencies and healthcare regulatory body which is keen to upgrade and modernize the healthcare institutions on a limited timeline. This up gradation and modernization is not only targeted for medical facilities and services but also focused towards other areas of the healthcare institution. Areas that can improve employee skills, commercial activities and decrease attrition rate while attracting the most qualified staff to hospitals from the world. This drive of change has converted many hospitals to western style healthcare institutions and these hospitals have benefited immensely from this endeavour. This activity is the need of the hour although the speed of modernization process is very inefficient with limited staff and expertise. It usually takes 3 years to revamp and restructure a mid-sized hospital in to a western like facility. At this slow rate damage at Marfraq hospital would have already been done. 4. The Problems and Need for Decisions The problem at the organization is not singular and could not be dealt with by a narrow approach. There are various problems but the core of it belongs to the leadership approach of Mr. Amin’s bureaucratic style of leadership and his followers who resist the change and promote the continuation of old methods and deteriorating systems and processes. This paved the way to abysmal managerial behaviour effecting the goals of the organization and development efforts along with demotivated staff with high attrition rate. The whole institution has lagged behind in comparison to other hospitals not just in medical practices but also as an organizational unit. Their management practices are abysmal, leaving the staff de-motivated; inefficient processes and HR practices result in poor patient treatment, high attrition rates, and lack of skills in the prevailing human resources. The root of all these problems is that the leadership of the institute is satisfied with the current scenario and refuses to change the prevailing traditional practices. The hospital is crying out for modernization not only in the medical field and practices but also as an organization with professional management, concrete human resource practices, and talent management activities. After the appointment of Mr. Richard, the contemporary employees expected rapid changes and improvements although Mr. Amin and his band of bureaucrats stood in his way and his initial proposal to turn things around was rejected. In face of such rejection Mr. Richard did not gave up hope and he steadily started taking in to confidence other Senior management members while creating good relationships with middle management, doctors surgeons, nurses and even lower level staff. He noticed that people who were disgruntled with Amin’s policies were drawn closer to him although no one was ready to voice their concerns formally. Using his charisma Mr. Richard became famous for his friendly approach and knowledge of the medical field along with other areas of management such as HR, marketing and information technology. Although due to language barrier and strong loyalty of Emirati staff towards Amin he was only able to attract attention of employees who were from other countries with some understanding of English and awareness of practices followed in other hospitals. Using his recruitment and interpersonal skills he was able to attract and retain top notch doctors although Mr. Amin’s practices made things worrying for the highly skilled talent. As hoards of employees started sympathizing with Mr. Richard’s approach Amin started penalizing those who raised their concerns over the current practices. Clearly there were two factions of employees, those who supported the approach of Richard but were scared to voice their concerns and those who were supporting the obsolete methods of Mr. Amin. The supporters of Amin whether senior middle or lower levels management were considered as watch dogs by Mr. Richard’s supporters and actions were taken against those who did not followed their ways. There were instances were nine employees were terminated in information technology department for trying to replace a decade old patient registration system with a latest software offered free to hospitals by World health organization (WHO). When refused these employees voiced their concerns and emailed the government authorities for enforcing this change to increase efficiency although Amin’s strong links with the government agencies came in action and no substantial actions were taken. As a result of these terminations employees started fearing for their jobs and many people who previously supported Richard stopped responding to him or following his instructions. Marfraq has no formal HR policies and procedures, they follow the labour laws and develop memorandums in order to inculcate changes made in UAE labour laws. The essence of human resources lies in recruiting, training and retaining the best available talent in the market. Alongside HR must also develop performance management system, training and development programs, recognition programs, competitive career paths and compensation packages. All these activities are important to keep employees motivated and perform the best in their respective roles. The current approach of Marfraq has no room for such provisions, recruitment is not proactive and efficient recruitment channels are not used at all. Performance is not a criteria for promotion or increase in pay and it is observed that those who supported and followed Mr. Amin religiously were rewarded and promoted. Furthermore rewarded managers only promoted and recognized those subordinates who followed and supported them. The creative section of employees were marginalized and ignored hence skilled staff left Marfraq in this situation, resulting in poor patient care and services. The competition between both factions have resulted in a somewhat hostile work environment where both factions fail to cooperate with each other or work as a team. The UAE citizens and government wants to increase Emirati staff in the healthcare sector by creating new job opportunities or decreasing the foreign staff. This action resulted in more dissatisfaction, people started worrying about their employment with Marfraq and were drawn closer to each other and eventually closer to Richard. Similarly marketing activities at Marfraq are also negligible. The concept of marketing in hospitals and healthcare systems is not just about increasing your customer base but it’s much more. A responsible hospitals earns a brand name for itself by spreading awareness in the general masses and by providing premium care services for its patients without any discrimination. In the western world many diseases and incidents are avoided by responsibly campaigning about the health problems. At Marfraq there are no formal healthcare awareness programs, the promotional and awareness channels used by other hospitals include newsletters, web site, emails and banners etc. This provides patients with the much needed awareness about common occurring diseases but also creates trust in the hospital and their staff. Furthermore public hospitals do not apply modern techniques of marketing for creating good will in the market and attract customers by providing similar services as private or western hospitals. The information technology department of the hospitals is as old and inefficient as it gets, frequent shut down, errors and hardware malfunctions create much hassle for the employees and customers. Although the supporters of Mr. Amin are adamant on continuation of old practices, such as an obsolete software that manages patient record and printing utilities. These applications are not linked to the internet hence sharing of patient records across all hospitals is not possible. Modern hospitals utilize ate of the art hardware and software to enhance efficiency and effectiveness of their operations. A central patient management system allows patients to share their records throughout the healthcare network. Furthermore it allows them to keep a track of their progress, schedule visits and get reports after a medical examination. Amongst the key personnel only Mr. Omar is supportive of Mr. Richard, while Mr. James Gaus supports Mr. Amin and Mr. Abdullah is neutral in his approach. These five people make up the executive body responsible to make majority of the decisions. Although in practice executive committee meetings are ineffective as major decisions are always made prior to the meeting by Mr. Amin with cooperation of Mr. Abdullah. These meetings are only conducted to inform the other three members of the decisions that have been made by Mr. Amin. This practice has demotivated Mr. Richard and Mr. Omar very much and their voice is subdued by the other faction. After much hue and cry Richard went on to meet the UAE health minister for registering his concerns although he was not satisfied as the minister convinced him that investigations will take place but it will take time. Since then no action or an observable action was taken against the bureaucratic approach of the current management. This visit was not reported to Mr. Amin although tactics to undermine the experience and abilities of Mr. Richard and Mr. Omar are always in practice. Mr. Richard as a leader faces a dilemma so late in his career, he has grown fond of the people around him and leaving the job would be considered as betrayal not only by his supporters but also to himself. His patience is running out as his demands are not met nor does Mr. Amin pays heed to the urgent needs of the facility. A run away from the dilemma is not a solution for Mr. Richard. Although he has the support of majority of the staff but this support remains silent hence all the power is exercised by the other faction. There are many possible solutions that Richard is taken under consideration although some of them can have devastating effects for his own career and that of his supporters. He wants to bring the change by either one of the following approaches; • The first approach is the most severe one, it involves calling a strike against the regime of Mr. Amin. This action is also supported by Mr. Omar who believes that at least 60% of the total staff will participate in the strike. Mr. Richard is perplexed on one hand he is sure that something needs to be done although he also knows that Mr. Amin can take severe action against the individuals that go on strike. Furthermore he is also not sure about the number of people who would actively participate in the strike. Although devastating in many ways this can bring about an instance change the stance of ministry or the government on such an action is hard to determine for him as he has not experienced the Middle Eastern culture before. • The second approach involves Mr. Richard taking a strong stance in coming days as he is the only one that can reach and convince government authorities and the board of directors to adopt modernization practices. He has been a new addition to the leadership team and past instances reveal that Mr. Amin would not support his initiative as he wants the traditional management practices to prevail. Going against Mr. Amin can be devastating for both Mr. Richard and any other supporting personnel. • The third approach is to convince Mr. Amin for modernization and make him an instrument for change. This change in the belief of Mr. Amin would take steady efforts and time along with activities that can enlighten and convince him to adopt modern practices. A proposal can be presented to him although a harsh rejection upon such a proposal is apparent until his mind-set develops. Mr. Richard in this scenario can play the waiting game and develop the mind-set of Mr. Amin by including him in meaningful medical conversations and modern western medical conferences and discussions resulting in acceptability of modern practices. After all that has been said and done this action would require much sacrifice from Richard as the gulf between both parties is huge. Additionally Mr. Richard feels that the magnitude of change required in Amin’s personality is a nearly impossible to achieve. • The fourth approach as leader involves him to continue building his support and win the hearts and minds of people working with him. When the support is overwhelming the change would come by itself, while this would require endless efforts to spread awareness about the disadvantages of Mr. Amin’s approach and advantages of modernization. This would require the most time out of all the approaches as all the power positions are all taken by the Emirati nationals who know less or no English. A very small portion of Arabic speaking individuals support Richard only because they have also been hard done by Mr. Amin’s policies. The language barrier is also proving as a dilemma for Mr. Richard, he feels helpless when Mr. Amin starts Arabic conversations in front of him which he cannot understand. • The fifth approach is to confront Amin with other executive committee members and tell him how he feels along with what he thinks should be adopted in the hospital in order to make it a great healthcare institution at par with top notch medical facilities. This would again provide either good or bad results instantaneously with no one else but Richard himself losing his job or triumphant after convincing Mr. Amin. • The sixth approach is to sacrifice his own job by placing his resignation after securing another opportunity in a conducive country and environment. Since the resignation would be personal in nature other supporters of Richard would not be targeted by Mr. Amin. This would although delay the change process but it will eventually come to Marfraq once the ministry decides to upgrade it. In that scenario Mr. Amin would have to accept the change enforced by the authority institution although the perils at Marfraq shall continue as present. 5. Questions In the current scenario where an organization is held back by its leadership and its followers resulting in inefficiencies and demotivation to major fraction of the workforce, as a leader what should Mr. Richard do and what approach should he prefer in order to bring a change without any devastating effects? As a curious management student, what do you think is the most appropriate choice Mr. Richard should make? Explain in steps? Furthermore can you suggest an alternate approach besides the six approaches explained in the case study? Imagine yourself in place of Mr. Richard what emotions should you be facing if you are in such a scenario and where would it lead you? What are the advantages of a bureaucratic system can you name two of them mentioned in the case study? References SEHA.org (2008). Al Mafraq Hospital, Retrieved from http://www.seha.ae/seha/en/Pages/HospitalDetail.aspx?HospitalId=13 mafraqhospital.ae (2013). 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