The Impact of Profitability on Leadership and Accountability in a Public

University Dental Clinic

Trimone Avery, Lindsay Burleson, Asia Carter, Vivian Ojimadu, Nylah

Singleton, and Madelyn Stevens

HSMT 4101-001

November 26, 2019

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 THE OPENING OF THE CLINIC
Southern University designed and built a new dental clinic in one year with a capital improvement fund and
student money, therefore resulting in no debt loan. The dental clinic was designed by an experienced Dental
Consultant with over 30 years of experience. No one on the leadership team had any background in dental offices
and relied on the Dental Consultant heavily which ultimately lead to her becoming the Founding Director of the
Dental Clinic. The clinic was designed to be innovative and profitable while also serving the needs of more people
on and off campus. The clinic was very successful the first year, however, suffered from many internal conflict
issues as a result of poor leadership and lack of structure and compliance.

LEADERSHIP/MANAGEMENT STYLES IMPACT ON TEAM DYNAMICS

HEALTH CENTER DIRECTOR
● Analytic decision style
● Transactional Leader (Giltinane, 2013)
○ Offer rewards in return for their compliance
● Blake and Mouton’s Leadership Grid: impoverished manager
(Borkowski, 2016)
○ Minimal effort on accomplishing tasks
○ Focuses on their own well-being
Trying to avoid conflict, the Health Center Director was very
accommodating to the Dentist’s wants for his position at the Dental
Clinic. By changing the organizational chart where the Dentist would
bypass the Dental Director, he undermined the Dental Director’s
authority. Doing this made the team dynamics almost non-existent.
In turn, it was awkward and essentially wrong, because he did not go
through the right channels to executively make this decision.

DENTAL DIRECTOR The Dental Director did try to act as a mediator to try and resolve staff
● Conceptual decision style conflicts and persuade them to comply to responsibilities they were
● Transformational Leader (Giltnane, 2013) hired for. When trying to address the Dentist, she did not stand up to
○ Directed towards the organization & influence of him and resolve the issue. She had a vision for the future of the dental
institutional change clinic, however, she did not have any structure to put this plan into
● Blake and Mouton’s Leadership Grid: middle-of-the-road manager effect.
(Borkowski, 2016)

DENTIST The Dentist and the clinical staff did not respect the Dental Director as
● Directive decision style an authority figure. They complained of working too many hours for
● Controlling, power-oriented, and close-minded (Borkowski, 2016) not enough pay. They created a hostile work environment with the
● Blake and Mouton’s Leadership Grid: authority-compliance/task abrasive communication that was used. The Dentist created a division
manager (Borkowski, 2016) in the staff by undermining the Dental Director.

Challenges:
The initial conflict between the Dentist and Dental
Director started the negative path for the clinic. The
Dentist did not want report to someone with no
clinical experience, and the Dental Director wanted
the Dentist to perform all of the services provided,
rather than refer patients to other specialists. The
Dentist refusing to perform services directly
impacted the clinics ability to be self-sustaining. The
Dentist would also undermine the chain of authority,
and report directly to the Medical Director and the
Health Center Director, setting a bad example for the
rest of the clinical staff. The clash of personalities
and the lack of willingness to complete job
responsibilities became more apparent as the demand
for the clinic increased.

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 The Dental assistants, Hygienists, and Dentist all felt complete certain aspects of their jobs, this created a
like their pay was inadequate in comparison to the negative mindset within the clinic and affected the
amount of stress and responsibilities that their jobs clinic as a whole.
included. Due to the clinical staff refusing to

Conflict Management:
The Health Center Director created an organizational culture that lacked structure and support. He did not have clear
processes and policies in place when reporting issues and managing conflict. When the
dental director was faced with challenges with the dentist he did not give helpful advice, but instead would say
things such as, “Don’t let him walk all over you. Enforce your goals and motivate him to change”. The health center
director’s “open door policy” made it difficult for chains of commands to be followed and for those that were higher
on the organizational chart to be respected by subordinates. In addition, the Health Center Director’s revised
organization chart allowed for unqualified people to have more responsibilities when they were unable to handle
their initial job duties creating further dissention.

RESISTANCE :
Throughout the opening months of the dental clinic, challenges began to arise which called for change in
management. When looking at the results from outside of the organization, the change in management resulted in
positively, with the organization being highly successful operationally and financially. However the change in
management resulted in resistance internally. Resistance was predominantly evident in the three key leaders of the
dental clinic: The dentist, dental director, and health care director.

Dentist Dental Director Health Center Director

- Once promoted to higher leadership
position, the dentist avoided
communication with dental director
- The Dentist did not want to attend
suggested team building workshops.
Leadership style: According to Blake and
Moutons leadership grid, they would fall
under the authority compliance and task
manager due to their lack of concern for
staff but high concern for productivity.
- When the dentist and dental assistants
reported issues to dental director , instead of
listening and addressing their issues, she
rebutted and stated that their 6 weeks paid days
off , and leaving at 5 pm everyday was fair
compensation
Leadership style : According to Blake and Moutons
Leadership Grid, the dental director displayed a
middle of the road leadership style . Although she
did not neglect their complaints, she did not fully
address them as an ideal manager would. An ideal
manager would have also considered how their
issues may affect the overall productivity. If an
employee continues to feel they are being
overworked, it is likely they could result in a
burnout.
- When the dental diretor was demoted , the
health center director held meetings from jun-aug
which excluded the dental director.
- Suggested dental director apologize to staff
because they did not like her leadership style
Leadership style: The health center director’s leadership
style would most likely fall under the impoverished
manager , on Blake and Moutons Leadership grid. The
health director neglected to follow the organizational
flow of leadership, allowing room for confusion and
miscommunication. These traits show how the health
director had a low concern for both the staff as well as
the productivity of the clinic.

Because of the lack of strong, adequate leadership and poor conflict management resolutions over long
periods of time clinical staff did not respect the leadership team and were not motivated to do work because of the
Health Center Director’s threat to terminate all of them if they could not work harmoniously. Employees were faced
with two potential negative choices to choose from in this situation; stay at the Dental Clinic and continue working
in non-conducive work environment or leave and have to take on the struggles of finding new places of employment
and possibly facing relocation. This is described as an avoidance/avoidance type of intrapersonal conflict

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 According to Rahim conflict is defined as an “interactive state” manifested in disagreement or differences,
or incompatibility, within or between individuals and groups. Conflict arose during staffing disagreements that went
unresolved and the various leadership styles that led to inconsistencies across the chains of leadership that lead to
dissention. This dissention created a lack of trust between nonclinical staff and upper-level management that in turn
led to high employee turnover as reported in employee satisfaction surveys reporting an overall lack of trust in the
Health Center Director and overall loss in efficiency for the Dental Clinic.

Due to the unexpected high volume of the clinic, it called for a change in management and managerial
styles, which resulted in different forms of conflict between staff. However had the clinic been located in a country
such as Canada where healthcare is universal, or in Costa Rica where many dental procedures cost significantly less
than that in the United States, would the clinic have had these same challenges. It is noted in the case study that cost
at thelinic were much less than that of local dental clinics. Had the United States provided universal care or lower
cost for dental care, the clinic would have received less patients reducing the demands and stress on the dental clinic
staff.

WHAT-IF ANALYSIS
The Dental Office endured many challenges within
the first 3 months of opening. All of these conflicts
were examples of interpersonal conflicts within the
Dental Clinic. If I were the Dental Director, I would
have done a temporary hiring program to see which
candidates would best suit the program provided at
the university. The soft opening would have been a
test run for a permanent position so that potential
conflict could be evaluated before hiring. I also
would have issued a contract that would state the
work requirements for each position available within
the Dental Clinic. Establishing a group that works
well together is one of the key components of having
a successful business. It is difficult for a person to
effectively manage the clinic if they do not possess
qualities of a competent and qualified professional.
Moving forward, as the Dental Director it would be a
priority to develop a relationship consisting of open
and clear communication with the clinical leadership
team so that future conflicts will be minimal. In
retrospect a specific form of interpersonal conflict is
described as differences in perspective. Although the
non clinical staff often questioned the decisions of
upper level management, upper level management
often stood by decisions made and it is our opinion
that the choices made were the in their perspective
for the overall good of the company.

GOING FORWARD
Rational Approach (Hispanic and Pacific Islanders/ Marshallese Cultures vs. US culture)

Marshallese Culture US Culture (Dental Clinic)

Organizational Development

Communication

Decision Making

If the dental clinic incorporated a rational approach and proactive coping perspective as described in
Borkowski’s Organizational behavior, theory, and design (2013) , they could have had the resources to help prepare
them for the challenges that were to come. For example, had the clinic leadership team provided hardiness training
for the staff, they would have had the necessary resources and coping mechanisms to best avoid build up of stress,
which caused the negative attitudes and behaviors within the team. According to Borkowski (2016) when stress
management programs were incorporated into health care organizations, the percent of malpractice cases dropped
significantly, showing a positive correlation between stress management programs and improved quality of care.

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 GROUP CONTRIBUTIONS

ASIA CARTER: Organizational Structure, Coordinated group meetings, Conflict Management,

and formatting

MADELYN STEVENS: Organizational structure, Coordinated group meetings, Challenges and

formatting

NYLAH SINGLETON: Resistance to change, going forward, and formatting

TRIMONE AVERY: What-if analysis, attended group meetings, and brainstorming template

VIVIAN OJIMADU: Organizational Structure, Coordinated group meetings, Conflict

Management, and formatting

LINDSAY BURLESON: Leadership/Management Styles chart and formatting

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 REFERENCES

Borkowski, N. (2016). Organizational Behavior, Theory, and Design in Health Care

(2nd ed.). Burlington, MA: Jones & Bartlett Learning.

Giltinane, C. (2013). Leadership styles and theories. Nursing Standard (through 2013),

27(41), 35–39. https://doi.org/10.7748/ns2013.06.27.41.35.e7565

McElfish, P. A., Long, C. R., & Rowland, B. et al.(2017, August 3). Improving Culturally

Appropriate Care Using a Community-Based Participatory Research Approach:

Evaluation of a Multicomponent Cultural Competency Training Program, Arkansas,

2015-2016. Retrieved October 22, 2019, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542547/.