1.

Contracting and Diagnosis stages:

In the contracting stage, the OD consultant needs to clarify the purpose, goals, scope, and expectations
of the intervention with the stakeholders involved, such as the CEO, the Vice Presidents, Don, and Mary.
This could involve defining the problem, identifying the desired outcomes, setting up the process,
specifying the resources needed, and establishing the roles and responsibilities of each party.

In the diagnosis stage, the OD consultant needs to gather data and information to understand the
underlying causes and dynamics of the problem. This could involve using various methods, such as
interviews, surveys, focus groups, observations, and document reviews, to identify the issues, the
stakeholders' perspectives, the patterns of behavior, the sources of conflict, and the opportunities for
improvement. The OD consultant also needs to analyze and interpret the data to develop a preliminary
hypothesis or theory of change that will guide the intervention.

2. Differences in approach:

If I were to approach the case, I would follow a similar approach as the OD consultant described in the
case. However, I might have done the following things differently:

 I would have sought to understand the stakeholders' perspectives and expectations more
explicitly, such as their values, beliefs, assumptions, and goals, to ensure that the intervention
aligns with their needs and aspirations.

 I would have used a more participatory and collaborative approach to engage the stakeholders
actively in the contracting and diagnosis stages, such as involving them in co-creating the
problem statement, defining the success criteria, and designing the data-gathering process.

 I would have used a more systematic and rigorous approach to diagnose the root causes and
dynamics of the problem, such as using a combination of qualitative and quantitative methods,
triangulating the data from multiple sources, and validating the findings with the stakeholders.

 I would have explored a wider range of possible interventions that could address the problem,
such as team-building, conflict resolution, communication skills training, leadership
development, and culture change, and evaluated their feasibility and effectiveness in light of the
diagnosis findings.

3. Third-party intervention and other OD interventions:

Third-party intervention is an appropriate intervention in this case because the relationship between
Don and Mary is so complicated they needed a neutral mediator to facilitate communication,
collaboration, and problem-solving. Third-party intervention is a type of OD intervention that involves
bringing in an external consultant or facilitator to help two or more parties resolve a conflict, improve
communication, and build trust.

Other possible OD interventions that could be considered in this case are:

 Team-building: This intervention focuses on improving the interpersonal relationships,

communication, and collaboration within a team. Team-building interventions can help Don and
Mary to develop empathy, mutual respect, and shared goals.
 Conflict resolution: This intervention focuses on resolving a specific conflict or dispute between
two or more parties. Conflict resolution interventions can help Don and Mary to clarify their
positions, interests, and needs and find a mutually acceptable solution.

 Communication skills training: This intervention focuses on improving the communication skills
and strategies of individuals or groups. Communication skills training interventions can help Don
and Mary to express themselves clearly, listen actively, and give feedback constructively.

 Leadership development: This intervention focuses on developing the leadership skills and
competencies of individuals or groups. Leadership development interventions can help Don and
Mary to enhance their emotional intelligence, problem-solving, and decision-making skills.

 Culture change: This intervention focuses on transforming the organizational culture by

changing the shared values, beliefs, and behaviors of individuals and groups. Culture change
interventions can help Don, Mary, and the OR to develop a more collaborative, inclusive, and
accountable culture

The third-party intervention put into place by the OD consultant showed to be effective in
resolving the interpersonal conflicts between Don and Mary and improving the overall
collaboration and problem-solving issues of the team. The consultant used a systematic
approach to address the problems as well as providing support and guidance to the team
members. The contracting and diagnosis stages helped to identify the key issues and establish a
shared understanding of the problem. The alternative solutions and decision stages helped to
develop and gave effective solutions. The consultant also provided continuous support by doing
follow-up by doing meetings with Don and Mary and the three vice presidents which helped to
make sure the changes were maintained over time.

The next steps for the Lincoln Hospital would be to continue to monitor the progress and
effectiveness of the solutions put in place and handle any new issues that come up. The hospital
should also focus on promoting a culture of collaboration and accountability, where team
members are encouraged to work together towards common goals and take ownership of their
responsibilities. This can be done by providing ongoing training and development opportunities
for staff, promoting open communication and feedback, and recognizing and rewarding positive
behaviors and outcomes. Also, the hospital should create a system for looking at and keeping
track of performance to make sure improvements made are maintained in the long term.

Issue

The main issue at Lincoln Hospital is a breakdown in communication and collaboration between the
two key leaders, Don and Mary, which is negatively impacting the overall effectiveness and success
of the hospital. This main issue can be broken down into several sub-issues, including:

1. Lack of trust: Don and Mary do not trust each other, which has created a hostile and
uncooperative work environment.

2. Poor communication: There is a lack of clear and open communication between Don and Mary,
which has resulted in misunderstandings and a lack of alignment around hospital goals and
priorities.
 3. Ineffective leadership: Don and Mary's inability to work together has created a leadership
vacuum, which is impacting the overall effectiveness of the hospital.

4. Low morale: The hostile work environment created by the breakdown in communication and
collaboration has led to low morale among staff, which is impacting patient care and outcomes.

5. Lack of accountability: Don and Mary are not holding each other accountable for their actions
and decisions, which has led to a lack of follow-through on commitments and a lack of progress
towards hospital goals.

Context

The Lincoln Hospital case is centered around a healthcare facility in a large metropolitan area that
serves a primarily low-income and minority population. The hospital is struggling with various issues,
including financial instability, declining patient satisfaction, and poor relationships between the
hospital's chief of surgery, Dr. Donald Berwick, and the head nurse of the operating room, Mary
Styles.

The tension between Dr. Berwick and Styles has led to a breakdown in communication and
collaboration, with both parties blaming each other for various problems in the operating room. This
has resulted in poor patient outcomes, staff dissatisfaction, and low morale, with staff members
taking sides and avoiding interaction with the other party.

Additionally, the hospital's financial situation has worsened, with declining reimbursements and
increasing costs leading to the need for significant cost-cutting measures. These measures have
further strained relationships between Dr. Berwick and Styles, with each party blaming the other for
the need to cut costs and reduce staff.

The hospital's board of directors has recognized the need for intervention and has hired an OD
consultant to help resolve the issues. The consultant has conducted a contracting stage to gain a
clear understanding of the situation and is now moving into the diagnosis stage to identify the root
causes of the issues and develop a plan for addressing them.

Ethical issues

One potential ethical issue at Lincoln Hospital is the lack of communication and collaboration between
two key figures, Don and Mary, which has resulted in a negative impact on patient care. This issue raises
questions about professional responsibility and the ethical obligation of healthcare providers to work
together to ensure the best possible outcomes for patients.

Another potential ethical issue is the unequal distribution of power and authority among staff members,
which has led to a culture of blame and finger-pointing instead of constructive problem-solving. This
issue highlights the need for ethical leadership and a commitment to creating a work environment that
values open communication, collaboration, and mutual respect.

There may also be ethical concerns related to the use of a third-party consultant to intervene in the
conflict between Don and Mary. While the consultant was able to help facilitate communication and
collaboration, there may be questions about the ethical implications of involving an outsider in resolving
internal conflicts within the organization.
Overall, the ethical issues at Lincoln Hospital center around the need for a culture of collaboration,
effective communication, and ethical leadership to ensure the best possible outcomes for patients and
staff members alike.

Alternative solutions

Alternative 1: Bringing in an external mediator Pros:

 An external mediator can bring in a fresh perspective and help the parties involved to see the
situation in a different light.

 A mediator can help to create a more neutral and safe environment where the parties can
express themselves more openly and honestly.

 Mediation is less costly and less time-consuming than litigation or arbitration.

Cons:

 The parties may not be willing to work with a mediator, particularly if they feel that they have
been wronged or that their interests are not being represented.

 If the parties have a history of conflict or mistrust, it may be difficult for a mediator to build
rapport and establish a productive working relationship.

 Even with the help of a mediator, there is no guarantee that the parties will be able to resolve
their differences.

Alternative 2: Separating the departments Pros:

 Separating the departments can help to reduce conflict and promote a more peaceful work
environment.

 Each department will be able to focus more on their own goals and priorities, rather than feeling
pressure to cooperate with the other department.

 Separating the departments may make it easier to hold each department accountable for their
own performance.

Cons:

 Separating the departments may lead to a lack of collaboration and cooperation between
departments, which could impact patient care.

 Separating the departments may not address the root causes of the conflict, which could lead to
ongoing tension and problems down the road.

 Separating the departments could be costly, particularly if new facilities or equipment are
needed.

Alternative 3: Implementing a joint management structure Pros:

 A joint management structure could help to promote cooperation and collaboration between
the departments.
  A joint management structure could ensure that both departments are held accountable for
their performance, rather than placing blame on one department or the other.

 A joint management structure could lead to better communication and shared decision-making.

Cons:

 Implementing a joint management structure may be difficult if there is a history of conflict and
mistrust between the departments.

 A joint management structure could be costly, particularly if new personnel need to be hired or
trained.

 There may be resistance from one department or the other if they feel that their interests are
not being represented fairly.

Solutions

Implement a conflict resolution program. This program will provide a structured approach to resolving
conflicts between employees and departments, and will help to promote collaboration and effective
communication throughout the organization. The conflict resolution program will follow a mediation
process, where a trained mediator will work with the parties involved in the conflict to identify the
issues, facilitate communication, and help develop solutions that are acceptable to all parties. This
program will be implemented organization-wide, and all employees will be required to participate in the
program.

Pros:

1. Provides a structured approach to resolving conflicts: The conflict resolution program provides a
clear and structured process for resolving conflicts. This helps to ensure that conflicts are
resolved in a timely and effective manner, and that all parties are satisfied with the outcome.

2. Promotes collaboration and effective communication: The conflict resolution program promotes
collaboration and effective communication by encouraging employees to work together to
resolve conflicts.

3. Prevents escalation of conflicts: By providing a structured approach to conflict resolution, the

conflict resolution program can help prevent conflicts from escalating and becoming more
serious.

Cons:

1. Requires training and resources: The implementation of the conflict resolution program will
require training for all employees and the allocation of resources to support the program.

2. Resistance to change: Some employees may resist the implementation of the conflict resolution
program, and may be reluctant to participate in the program.

3. Not all conflicts can be resolved: While the conflict resolution program provides a structured
approach to resolving conflicts, not all conflicts can be resolved. In some cases, additional
interventions may be required to address underlying issues.
The conflict resolution program provides a structured and effective approach to resolving conflicts
within the Lincoln Hospital. This solution aligns with the OD principles of collaboration, communication,
and problem-solving, and can help to create a more positive organizational culture.

Business case

Lincoln Hospital should focus on collaboration between Mary and Don. This solution is the best choice
because it takes care of the main issues between the two important people responsible for the smooth
operation of the OR. The joint problem-solving approach will make sure that both Mary and Don are
held responsible for resolving problems and encourages them to work together towards finding
solutions. The business case for this solution is based on the possible cost savings associated from
increased efficiency and communication in the OR. By looking at the issues of poor communication, lack
of collaboration, and ineffective problem-solving, the joint approach can help reduce the number of
errors, delays, and conflicts that can arise in the OR. This will lead to reduced costs associated with
longer patient stays, repeat surgeries, and litigation that could happen from medical errors. This can also
help OR and can help increase patient satisfaction and reduce staff turnover rates, which can also help
them financially. This can lead to increased revenue and patient referrals that will help them stay
competitive.

In terms of frameworks, the business case for this solution can be evaluated using a cost-benefit analysis
(CBA) or return on investment (ROI) analysis. A CBA would help quantify the costs associated with
implementing the joint problem-solving approach (e.g., time and resources required for training and
development) against the potential benefits (e.g., cost savings from reduced errors and increased
efficiency). An ROI analysis would evaluate the financial benefits of the joint approach against the initial
investment required. Both frameworks can help establish the business case for the chosen solution and
demonstrate its potential value to the hospital.

Implementation

The implementation of the chosen solution for the Lincoln Hospital case involves several steps that
require collaboration and communication among all parties involved. The following steps are
recommended:

1. Develop a communication plan: A communication plan should be developed to ensure that all
stakeholders are aware of the changes and how they will be implemented. The plan should
include the key messages, channels of communication, frequency of communication, and
responsible parties for communication.

2. Establish a team to monitor progress: A team should be established to monitor the progress of
the implementation process. This team should be made up of representatives from each
department involved in the process. The team should meet regularly to review progress and
address any issues that arise.

3. Develop a training plan: A training plan should be developed to ensure that all employees are
aware of the changes and know how to implement them. This plan should include the training
schedule, topics to be covered, and responsible parties for training.
 4. Implement the changes: Once the communication plan, monitoring team, and training plan are
in place, the changes should be implemented. This should be done in a phased approach to
minimize disruption to daily operations.

5. Evaluate the changes: After the changes have been implemented, an evaluation should be
conducted to determine their effectiveness. This evaluation should include feedback from
employees, patients, and other stakeholders.

The ADKAR model can be used to ensure successful implementation of the chosen solution. The model
focuses on five key elements: awareness, desire, knowledge, ability, and reinforcement. By following
this model, the hospital can ensure that employees are aware of the changes, desire to implement
them, have the necessary knowledge and skills to do so, and receive reinforcement to sustain the
changes.

Reflection

One key takeaway that I have from this case is how important it is to have really good communication
and collaboration when it comes to organizational success. It was obvious to me that the Lincoln
Hospital faced an unimaginable number of challenges that could have led to its closure due to poor
communication, lack of trust, and a culture of finger pointing. I feel as if Don and Mary handled
themselves super unprofessional and it should have been unacceptable for them to act the way they did
to the point to where the OR had delayed surgeries, scheduling issues, and nursing shortages.

Another takeaway I noticed was that the third-party intervention from the OD consultant helped to
change the dynamics of the relationships between Don and Mary. When it came to contracting,
diagnosis, and feedback, the consultant helped to establish trust, shared responsibility, and a focus on
solutions rather than issues. This approach led to change and improvement in the hospital's
performance and ultimately saved it from closure. This case highlights the importance of effective
leadership in promoting collaboration, trust, and accountability in organizations. I think this case
highlights the fact that leaders need to have effective communication, encourage teamwork, and
promote a culture of respect, and shared responsibility.