Hello Mrs.

Quimby,

Your interest in building better integration between behavioral health services and primary care
services in order to improve continuity and coordination of patient care is a good thing.
 Building better integration between these two departments requires effective
communication, teamwork and strong working relations.
 Attempting to separate the two would create personal and environmental barriers that
would negatively affect the new policies and procedures and create conflict.
 There are potential benefits but also potential drawbacks to a structure based on
bureaucracy. Bureaucratic structures can help get things done by allowing rules and
procedures to be followed. However, those same structures that help you get the job done
can also impede others from getting their job done.
Would you agree that focusing on positive working relationships build great teams and good
communicators? It would be difficult for the structural solution you have presented to be
effective as
 Adapting different policies and procedures for each department separately would create a
disconnect between the departments
 Creating an exception policy would also create further environmental and personal
barriers and mixed messages that would lead to miscommunication and weak working
relationships
Effective teamwork and communication work in unison. In the end customers are the ones who
are affected by the lack of teamwork and communication. I propose that
 A focus on teamwork culture
 Focus be set on building relationships between both services
 Feedback is necessary and should be exercised
 Any conflict should be addressed with high assertiveness and cooperation
 Weekly meetings be scheduled between both departments to discuss everyone’s feelings
and concerns

Thank you,

Ruth Fuster
Hello,

In response to the recurring conflict involving stat medication orders I ask that we work together
and analyze the problem and recommendations for solutions. Would you agree that
communication is key for patient safety?
When there is a lack of communication between departments
 The safety of the patient is at the forefront
 Failure in communication accounts for majority of serious medical errors
Potential communication problems can be
 At the basis of “The Basic Communication Model” where there is a disconnect between
message being send and the message being received.
 Due to the organizational culture that’s being practiced
 Due to a lack of role clarity
 On a personal level due to evaluation of the message sent
Here is a list of question that should be asked in order to attempt to understand what is at the root
of the problem
 Is all the relevant information in regard to the medication being communicated?
 Are the medications being given and received in a concise manner?
 Are the medication orders being communicated in a plan and clear form?
 Is there mutual accountability present between both departments?
 Is a culture of safety being practiced?
It is important to present closed-loop communication as a solution to this problem as it allows for
the receiver to restate what the sender has said. This confirms what is being requested, therefore
avoiding any errors. While we do this, we can catch any miscommunication and cancel any noise
that might be interfering with the message being sent.

Thank you,

Ruth Fuster
 Hospital of Performance and Improvement

MEMORANDUM

Date: June 5, 2020

To: Michelle Johnson

From: Ruth Fuster

Subject: Adapting a Safety and Trust Culture

Work in healthcare is complex, and there are numerous interactions amongst different
department and people. Effective communication is at the helm of all successful practices.
Lack of trust and communication between employees is blamed on the individuals
themselves. Nevertheless, it is important that the leaders and managers who are at the
forefront lead by example and offer effective communication skills, a safety and trust culture
along with teamwork that would lead to less medication errors.
After spending time in the units and speaking with the staff I was able to learn that the
frontline workers are aware of what is going on when it comes to medical errors. However,
there is no trust established and they feel that they would get in trouble if they speak up.
There needs to be a psychological safety in place, where the staff can speak up and not feel
that they would be punished or looked at differently. In this form of safety, the team itself
share a common belief that they are safe in taking interpersonal risks. Trust is extremely
important and the more the better. It allows for teamwork and effective communication. They
will feel that it is okay to speak up and discuss errors that affect patient safety. It is okay to
engage in task conflict and it is important for the members of each team to experience a
healthy level of psychological safety, so that they will share information of important matters.
Would you not agree that the hospital has adapted a hierarchical culture, and this might hinder
and lead employees to be hesitant to speak up about the safety issues that are occurring when
you visit the units? This bureaucratic aspect of this culture may obstruct the open, trustworthy
communication that is so important to safety. In this culture, people veer towards paying
attention to the rules and higher ranks. Also, predictability and standardization are valued in
this culture. Protocols and standardized processes guide the way and lots of times rewards are
based primarily on seniority and rank. It seems crucial that rules are followed, and the chain
of command respected in this aspect of organizational structure. Rules, job descriptions and
hierarchy are highly valued taking away from teamwork and positive working relations.
In response to such a hierarchical culture I propose that the hospital leaders move into a
flexible culture. One that would allow for more flexibility between employees and leaders and
allow for the staff to feel safe enough to report any errors. Interdependent relationships that
form the organization is what makes it a system. We have to look at culture as an organism,
as a living thing that is always changing. These cultures influence thoughts and behaviors and
with high flexibility there is a high placement on trust and encouragement. Flexible culture
along with external focus can better the communication, teamwork and trust of the frontline
workers. This focus shifts from leaders to the staff to pay attention to their environment. In
 particular I believe this hospital would benefit from a group culture- where teamwork is
supported, which is critical when it comes to patients and medical errors.
To begin and promote this change, I recommend that you schedule longer meetings with the
staff instead of the quick check-in. It is important to engage in active listening. Active
listening builds trust and establishes rapport. It demonstrates concern and can help manage
conflict better. Ask questions and do not blame, just try to understand others. Engage the staff
individually or in groups to explore the problems and ask for recommendations. Trust is very
important between task conflict and relationship conflict. The stronger the trust amongst the
staff, the better they will be able to handle task conflict and it won’t turn into relationship
conflict. In trusting others, it is also key for the staff to feel benevolence, take action and be
capable of getting things resolved.

Again, psychological safety is an important factor and plays a big role in patient safety.
Having a hierarchical type of culture can lead frontline employees to not speak up in fear of
retribution. Hospital leaders should attempt to move away from this type of strong
hierarchical culture and into a flexible one. Moving away from quick check-ins into weekly
longer meetings can help build trust and rapport and allow for positive results and fewer
medical errors.

Thank you,

Ruth Fuster
 Fairfax Sports Medicine and Physical Therapy

MEMORANDUM

Date: June 5, 2020

To: Board of Directors

From: Ruth Fuster

Subject: Strategic Planning

A successful strategic plan takes time and is very complex. It is important to comprehend
what is strategy, strategic planning and implementation. In our last meeting I was concerned
with the strategic plan of opening another office, as this is not an enough complete strategic
plan. In order to have a successful opening of another office, there are many processes that we
have to go through. We need to address many aspects and components such as environment,
market, customer and values.
Strategy is carefully planning how we will differentiate our practices from other practices and
create value for the patients that will receive our services. There are many others sports
medicine and PT practices across the states, we have to strategically answer the question of
“how are we going to compete?” A good proactive strategy can help FSMPT to be more
successful because if the strategic plan is developed and implemented correctly it can give us
a competitive advantage in the industry. Again, opening a new office in Herndon next year, in
itself is not a true strategy. Strategic plans also take about 3-5 years, it would be difficult to
have a good strategy to opening another location.
We need to begin to look at this organization as an open system, where we can see how
strategy focuses on both the internal and external environments. From this viewpoint of open
system our organization must be adaptable to the external environment, efficient in the
internal processes and effective in the outputs. An effective strategy takes into account many
aspects like value, environment, market, and customers. Also, there are steps that must be
taken like assessing the strategy, where we analyze the internal and external market to reach a
competitive analyzation. Then we need to develop the plan from the previously done
assessment. We then would move into the implementation which is basically putting into
effect the strategy that we have developed and finally we evaluate the effectiveness of the
plan and what has been put into effect is also assessed.
Before beginning the strategic planning, it is important to understand the mission, vision, and
values of FSMPT. We cannot plan for the future if we do not have a clear comprehension of
what we do and I. Also, we have to know what our vision is, what do we see ourselves in five
years? And what are our core values? This is answered by evaluating the organization as a
whole. I propose that a SWOT analysis to then be executed to determine the organization’s
strengths, weaknesses, opportunities, and threats. At an internal level is our strengths and
weaknesses and at the external level, opportunities and threats. It is important to develop
 these processes at the stakeholder’s level and include them in these analysis as well as the
strategic development. Scenario planning is also an important factor to include in the strategic
plan. This tool allows for a structured form of thinking about the future and the way things
may evolve that could disturb the organizations well-being. The next step would include the
implementation of the strategy plan, and this can be done by using a tactical operating plan.
The process of strategic planning like I mentioned before can take anywhere from 3-5 years.
In the meantime, we can use shorter-term, smaller scale plan that is intended in helping out
carry the larger goals in the strategic plan. While attempting to begin the planning process of
a strategic plan to open an office in Herndon next year, I invite you to contemplate some of
these questions:
What is our mission, vision, and values?
How will we add more value for our customers?
What will we do different than our competitors?
How resources do we currently have in Herndon?
How will we decide what not to do?
In which markets will we compete?

I hope this memo can help in visioning a better vision for the future and strategic planning.

Thank you,

Ruth Fuster