After reading the chapter on
organizing teams I was able to learn a lot about the importance of a functional
team and how its structure can lead to its success. When thinking of a successfully functioning
team, the first one that comes to mind is one from my favorite television
show. In the program Greys Anatomy, the
story of several young surgical interns is followed as they make their way from
first year interns to full time residents.
Throughout the twelve seasons, Meredith Grey (the lead character) and
the other employees of Seattle Grace undergo several leadership shifts and
changes, all for the betterment of the organization. Because the series is so extensive, and
throughout the program there are so many leadership changes and restructuring,
I will be evaluating the first season to make it a little less confusing.
To begin, the hierarchy of the
hospital, specifically the surgical department, is set up in a dual authority
configuration. With this system, there
is one head boss who is in charge of department heads. These department heads have a collection of
employees below them and the flow continues from there. With the hierarchy of Seattle Grace, there is
a chief of surgery (Richard Weber), who is responsible for the entire surgical
department at the hospital. He is the
one who hires interns and promotes the residents. It is his job to more or less ensure that the
surgical department is running smoothly.
He is the one who schedules all the surgeries. The interns see and respect him, but for the
most part, they do not deal directly with Weber. From there, Weber dictates to the department
heads. The departments are broken down by category of surgical need, such as
head of cardio and head of neurology.
These department heads are responsible for surgeries in specialized
fields. Derek Shepherd (head of
neurology), only receives cases that are specific to issues with the
brain. The same goes for the rest of the
department heads. The next level gets a
little tricky. The interns are the
lowest level on the hierarchy. They are
brand new to medicine and have little experience. This is Meredith’s position. What gets complicated is that the interns
rotate from department to department each week.
This allows them to get trained in every specialty. The interns take on an all channel, or
interconnected network under the department level. At any one time, the department heads are
working with three to four interns at one time.
This leadership structure works
well in the context of the show. Department
heads answer to the chief which prevents some of the power struggles that come
up from becoming an issue. In many
instances of the show, multiple department heads are called in for the same
patient, and they each believe what they are doing is the priority. It is Weber
who makes the final call on which doctor’s method of treatment will be
used. Also, the all channel network of
organization among the interns is beneficial as well. While having no set leader at the intern
level might seem bad for organization, the interns need to constantly be
working with a new department head in order to get a well-rounded
education. In the long run, they benefit
from working with a rotating leadership.
However, there are cases of conflict that arises from this type of hierarchy. For several characters, personality
differences prevent interns from receiving a full education from department
heads. This is the fault of the
department head for playing favoritism on specific interns. In a real, functioning hospital, this could
create a problem in that if a department head was doing that, one intern would
have a poorer education in that specialty which could result in casualty.
I haven't watched this show. I suspect there is some lack of realism in the way you describe things, especially who has final authority on decision making. My experience is that the patient contacts a specific doctor for some problem. For example, I was having problems with my shoulder a few years ago, so I contacted the orthopedist who happens to be the doctor for the football team at the U of I. That doctor then takes charge of the care of the patient.
ReplyDeleteThe way you described things with the head of surgery having ultimate decision power might make for good TV but likely would jam things up. (This is a command and control versus boots on the ground issue. I'm arguing here for boots on the ground.) Of course, scheduling the OR is a big deal. And there are things that can interfere with a planned surgery - complications in other surgeries or life threatening situations that require immediate treatment.
But there is a different sort of issue that you should consider, something that the TV shows don't look at but is really important economically with healthcare. This is how doctors get paid and how that, in turn impacts how they treat patients and how they communicate with other doctors who are also involved in that same treatment.
You might really enjoy reading this essay called The Cost Conundrum, by Atul Gawande, which gives a very good luck into why there are problems and what might be a way out. The piece was written before the Affordable Care Act was passed, but gives some insight on the type of medicine we'd like to promote.
Alas, my experience is that doctors don't meet the ideal that Gawande sets up in this piece.
I believe I explained the system wrong. In most cases, the head of surgery is not involved in each and every case that comes in. For routine procedures that are scheduled, the department heads do not need to confer with him. In some cases on the show, such as when a severe trauma comes in and multiple doctors are needed at once, he needs to make the decisions. I agree that in todays world, doctors and healthcare in general is a big issue. I will be interested to see how, in the coming years as healthcare is changing, what will happen to funding for doctors and hospitals in general.
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