OGL 481 Pro-Seminar I:

PCA-Structural Frame Worksheet

Worksheet Objectives:
1. Describe the structural frame
2. Apply the structural frame to your personal case situation

Complete the following making sure to support your ideas and cite from the textbook and other
course materials per APA guidelines. After the peer review, you have a chance to update this and
format for your Electronic Portfolio due in Module 6.

1) Briefly restate your situation from Module 1 and your role.

My role at BDP was a Senior Retina Technician with 12 years at the company,
and 20 years of cumulative eyecare experience. I provided critical testing to assist with
diagnosis and treatment of various retinal diseases and conditions.
The situation for my PCA is how the Covid-19 pandemic and subsequent varying
supply and Personal Protective Equipment (PPE) shortages disrupted clinical operations,
patient care, and exposed employees to frustrating and potentially dangerous working
conditions.

2) Describe how the structure of the organization influenced the situation.

The structure of BDP was a mix of both hierarchical and self-managing team
structures. The company as a whole was bureaucratic and hierarchical in nature. It had a
group of C-Suite executives that made company-wide decisions, sold the company, and
purchased and rebranded other clinics under our “umbrella” organization.

Our structure on the clinical side of the organization (the part that dealt directly
with patient care) mimicked the hierarchy of the company: Doctors decided how their
clinic was run, then the retina team manager and nurses were the next level down, team
leads were the clinic “go-to” persons for low-level decisions, and technicians did the bulk
of the testing and direct contact with the patients.
However, the clinic staff consisted of a highly-trained group of technicians,
experienced in dealing with a variety of issues: triaging emergencies, angry or
inappropriate patients, and performing various tests (usually determined by the technician
themselves while recording patient complaints). This type of autonomous, self-directed
team framework, as described by Bolman & Deal (2021), was a highly-efficient way to
run the clinic, as we didn’t have to check with higher-level staff to determine what testing
was needed for each patient.

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 This clinical structure also decreased patient wait times, and increased our clinic’s
capacity to see patients—all advantages with an ever-growing population of retina
patients and so few specialists in the state.
Unfortunately, the differing structures of the company became sharply skewed
back to a traditional hierarchy when the pandemic hit—executives worked from the
safety of their homes while clinc staff was expected to continue working directly with
large numbers of patients—many of whom angrily refused compliance with our increased
safety measures and required use of PPE.
Masks and gloves for staff were becoming scarce, and available PPE supplies
were locked away for physician and surgical use first. Each technician was issued one N-
95 mask, and we had to wear that same mask to work for up to a month at a time. Doctors
and clinic managers were issued a new mask each clinic day.
Disinfecting wipes became scarce, as they siphoned to hospitals first and
foremost. At one point, we had to use tissues dipped in alcohol to clean the rooms
between patients. We also ran out of some of our retina medications at few times, and had
to triage which patients were at most risk for losing their vision without it—an
unfortunate hierarchical structure in and of itself.

3) Recommend how you would use structure for an alternative course of action
regarding your case.

If I had the opportunity to recommend structural alternatives, I would have tried

to avoid the clear demarcation of who was most “important” to the organization. The
technicians came into direct contact with just as many patients as the doctor—and for
longer periods of time—yet we had the dirtiest PPE of the entire clinic. In fact, I would
argue that we required more PPE than the doctor, as the patients often removed their
masks to yell at us about policy or politics, purposely coughed and spit in our faces, and
we did procedures that involved patient blood and (sometimes) vomit.

Instead of tightening the vertical structure of the clinic personnel, I would have
tried to use tips from Hegelson’s “Web of Inclusion” (Bolman & Deal, 2021), with the
patient as the central focus, rather than the doctor or another upper-management person.
Focusing on efficiency of patient care, rather than “protecting the doctor” (something we
were told to do by a manager), would have kept morale as high as possible and kept the
focus on patient care.

We all understood the ramifications of the doctor getting sick with Covid, and
how detrimental that would be to clinic patients (and our other doctors that would have to
take on their patient load—sometimes upwards of 100 patients a day). In practice, using
the “Web of Inclusion” with the patient as the centerpoint, I would have placed each
patient in a room by themselves, rather than herding them through stations where they
contacted each member of our team. One technician would be assigned to gather patient

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 information, do the testing, then the doctor could enter that singular room to examine
them. With the structure of moving them all over clinic and exposing them to all the staff
(and other patients), we were unable to confidently wipe down everything they touched,
because we didn’t know. So we used more disinfecting supplies to continually wipe down
all waiting areas and every room they entered—an inefficient way to operate.

Another aspect of the inclusive structure would be evenly distributing available

PPE to the staff that had to deal directly with patients. We were all scared, and
technicians were especially terrified of the increase risk of exposure to our families
because we didn’t have a medical degree. Some effort to show us that we were being
cared for while caring for others would have gone a long way with employee morale (and
I might still be working there).

Ultimately, there was probably no perfect structure that could be employed—

everything was chaotic, including the patients themselves. Minimizing their contact with
clinic areas and technicians would have at least given us a sense of some level of
exposure control and care from management.

4) Reflect on what you would do or not do differently given what you have learned
about this frame.

The structure of self-managing teams operating under a Wizard-of-Oz-like

hierarchy is something I will never employ if given the chance. I know just how much the
“lowest-level” workers contribute to the organization—they are truly the foundation that
keeps the structure functioning. If we are trusted enough to make decisions in clinic about
patient testing, we should also be respected enough to share in protective equipment
when forced to work during a pandemic.
Going through the pandemic working at this eye clinic—one that I gave 12 years
of my life to—is what ended my career in healthcare. The self-serving nature of C-Suite
executives that were in no danger of exposure taught me that no matter what position I
hold in an organization, I will take into consideration how our actions affect those that
work at all levels.
It was an unfortunate and eye-opening lesson in working in a hierarchical
structure, and how those at the bottom of the hierarchy can sometimes be asked to do the
most for the least in return. Looking back, the only thing that I would have changed at the
time would be to quit at the beginning of the pandemic. The immense stress and worry I
felt coming to work every day and the abuses endured from patients, coupled with the
lack of back-up from upper management, aged me terribly in a short period of time. It
permanently changed me and my outlook on my work career. What once was the most
important thing in my life rocketed to the bottom of the list. I only hope I have the chance
to steer an organization away from a similar mentality at some point in my life.

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 References

Bolman, L. G., & Deal, T. E. (2021). Reframing Organizations: Artistry, choice, and leadership
(7th ed.). San Francisco, CA: Jossey-Bass.