After reviewing the attached case studies, answer the following questions about conflict within the health care issues you’ve chosen for the final research paper. The healthcare issue is the long-term effects of COVID-19 on healthcare.
1. Identify the health care issue you chose for the final research paper.
2. Identify and explain at least one conflict that exists (or will exist) within the issue you’ve chosen.
3. Why is there a conflict over these issues?
4. Who are the stakeholders in the conflict?
5. If the conflict exists currently, how is it being managed by each of the stakeholders? How can the existing conflict be resolved more effectively? Explain.
6. If this is a future conflict, how can the conflict be managed and how will the stakeholders be affected by the conflict? Explain.
7. Imagine that you are one of the stakeholders within the conflict, and explain what kind of leverage you might have in managing the conflict. What would you do to manage the conflict? 8. Will there be winners and losers in the conflict resolution?
Case Study 15-5 Health Care System Versus Insurance
UAB to No Longer Accept UnitedHealth Care After Negotiations Fail
At the end of the month, UnitedHealth care insurance will not be accepted at most UAB Health System
entities after the two companies failed to reach a contract agreement.
The end of UAB entities accepting United is July 31, and approximately 25,000 policyholders will be
affected.
“UnitedHealth care forced us in this position,” said UAB Health System CEO Will Ferniany. “We haven’t
had these kinds of problems with any other provider but United.”
Entities like UAB Hospital, The Kirklin Clinic, all other UAB Medicine primary care, specialty care and
urgent care clinics, UA Health Services Foundation, UAB Callahan Eye Hospital, Medical West and Baptist
Health in Montgomery are some of the UAB providers who won’t be accepting the insurance plans after
July 31. The change also includes all services provided by UAB doctors, regardless of where the service is
provided. The emergency departments at UAB hospitals will remain open to United customers, officials
said, and some United policyholders who have an open benefit plan may also be exempt from additional
charges when the change goes into effect.
Last month, the UAB Health System sent out 40,000 letters to patients who went to a UAB entity in the
past two years with United insurance to notify them they may soon have to pay out-of-pocket costs if no
agreement is reached. UAB currently accepts Medicare, Medicaid, Blue Cross Blue Shield of Alabama and
VIVA Health (an affiliate of the UAB Health System). The change won’t affect supplemental plans,
arrangements with Medicare or PEEHIP policies. “We recognize and appreciate that some of the services
UAB Health System provides are unique and more costly. We reimburse them accordingly for these types
of services,” a spokesperson from United said. “However, UAB Hospital charges significantly more than
other hospitals even for common services and tests.”
The university said it is opposed to the tier two designation which would make some of United’s
policyholders pay more to come to UAB, while United would pay less. In some cases, the extra out-ofpocket costs would be applied even if the patient had no choice but to come to UAB Hospital because of
the severity of their illness or the services needed. “UAB is demanding that they be designated a Tier 1
provider despite the fact that they don’t meet the criteria because of their egregiously high costs,” a
spokesperson from United said. “If we agreed to this demand, it would undercut employers’ ability to
design competitive benefit plans that reward their employees for choosing quality, cost-effective care
providers.” United said it would continue to pay the contracted rate no matter what UAB’s tier
designation is.
In their negotiations, Ferniany said United believed UAB’s costs should mirror smaller, less
comprehensive hospitals. These demands ignore the complexity of the services UAB offers, he said.
UAB is the only Trauma I center in Alabama recognized by the American College of Surgeons, which
causes the system to treat some of the state’s most critical patients. The hospital also serves as a public
safety net to other hospitals in the state that cannot provide the same level of care as UAB, Ferniany
said. Its charity costs are more than $70 million a year. “We are also opposed to a program that only
looks at price and not quality of care,” Ferniany said. He added the tier system isn’t fair to UAB, because
many patients must go to a UAB entity for various reasons related to their condition or illness. He asked
if UAB is the only place someone can go, why should they have to pay more? He also said United
shouldn’t punish UAB for being a teaching hospital, but recognize that Alabama would have far fewer
doctors without the residents who train there. Other insurance companies realize that, Ferniany said.
United is one of the most profitable insurance companies, according to data, and generates more cash
profit than all other national publicly traded health plans in the country combined. The company had $9
billion in earnings in 2018—profits that come at the expense of its policyholders and health care
providers, Ferniany said.
This is not the first time UAB could not reach an agreement with United. The two could not reach a deal
in 2005, and United was not accepted at the university from 2006 to 2011.
Raheel Farough, vice president of UAB Health System Managed Care, and Ferniany called the lack of
partnership a sad and unfortunate situation, but maintain that UAB will not accept something that puts
profits ahead of patient care. “The things they’re asking for… are just not things we can accept,”
Ferniany said. “This is very, very worrisome to these people. This is not a good thing.” Farough added
that United’s policies can harm patients, as the company will only pay for what they deem is medically
necessary, regardless of what’s best for the individual.
United has not been able to renew contracts with hospitals across Alabama and the country, according
to information from UAB. South Alabama Medical Center and University of Colorado Hospital/CU
Medicine were two of those hospitals, citing reasons including “frequent difficulty in obtaining
authorization for services needed by patients” that were often not paid for. The hospitals also mentioned
United’s refusing to pay health care providers after initially approving care. The two are still committed
to discussions of an agreement. “I’m planning to be reasonable,” Ferniany said. “They’ve not provided us
anything close to reasonable.”
United responded Friday: “Despite repeated efforts to reach a compromise, UAB has decided to put
Alabama residents square in the middle of this dispute. This is unfortunate and completely avoidable.
We hope UAB will reconsider so we can continue working toward a new agreement that will ensure our
members have continued access to UAB at a more affordable cost.”
What level of conflict is represented in this case?
What type of negotiation style did UAB use in this case?
What type of negotiation style did UnitedHealthcare use in this case?
Who are the winners and losers in this conflict?
Reproduced from Auglair, H. (2019). UAB to no longer accept UnitedHealth care after negotiations fail.
Al.com. Available from https://www.al.com/news/birmingham/2019/07/uab-to-no-longer-acceptunited-healthcare-after-negotiations-fail.html
Case Study 15-6 Musical Operating Rooms
Dr. John Wilkins sat staring at the phone message in front of him. Dr. Peter Mikelson, chief of
orthopedics, had called again wanting to discuss the current system used to schedule operating room
times. As chief of medicine, technically, Dr. Wilkins had the power to dictate who would use the
operating resources and when. Up to now he had been reluctant to use that power, relying instead on
scheduling administrators to handle the schedule for operating room use. Perhaps the time had come to
review that system and implement changes if necessary.
Mercy Hospital, a not-for-profit hospital located in the Northeast, employed 1000 doctors in 30 different
departments. The facility had an outstanding reputation as a teaching hospital. About 40% of its doctors
were full-time faculty, while the remaining 60% were volunteer staff (those doctors who, while not
employees of the hospital, worked with residents and had access to hospital resources). The hospital
currently had 25 operating rooms located throughout the hospital. Operating rooms were not assigned
to any particular department, but doctors tried to use the rooms closest in proximity to their department
wing. In some more extreme cases, it was simply understood that the operating rooms in certain wings
were to be used only by certain departments.
Dr. Wilkins decided to have some informal discussions with different department chairs to gauge how
dire the situation really was. His first stop was with Dr. Steve Daly, chief of urology. “You know, John,” Dr.
Daly explained, “I understand urology is not a high-profile glamour specialty, but I am having a very
difficult time attracting both volunteer staff and the best residents because of the trouble I have
scheduling procedures. We have 20 doctors in three different departments sharing four operating rooms.
I know to you this may sound like an inability on my part to plan, but let me put this in terms that may
mean something to you. The operating room is where we make our money. If my doctors and I can’t
easily schedule time in the OR, we can’t continue to build the department. I have already seen a decline
in the number of referrals from primary care physicians. If this keeps up, this hospital will have a hard
time maintaining this specialty at a competitive level.”
Next on Dr. Wilkins’s list was Dr. Jack Palmer, chief of neurosurgery. Jack Palmer was a bit of a legend in
the region. This was due to a combination of the high-profile nature of his specialty, his long tenure at
the hospital, and his impressive client list, which included many of the people who sat on Mercy
Hospital’s board of directors as well as their families and friends. As John walked through the
department, he noticed that all three of the ORs in the Neurosurgery wing were not in use. When he
mentioned this to the department secretary, she replied that this was always the case on Friday
mornings. For as long as she could remember, Neurosurgery held a weekly teaching conference from
7:00 to 12:00 every Friday. The secretary then informed John that Jack could not free up any time to
speak with him, but she did relay the message that all was fine in Neurosurgery as far as OR time.
Dr. Wilkins next spent some time with Dr. Sheehan, chief of ophthalmology. After reviewing the OR
schedule for the next month, Dr. Wilkins was astounded at the number of procedures Dr. Sheehan and
members of her department were scheduled to perform. Dr. Sheehan explained, “Well, John, I’ve
actually put a little cushion in there to make sure I have the time I need. At the beginning of the month I
sign up those surgeries I am sure we will perform as well as some ‘phantom’ patients. That way, if
surgery runs over because I’m teaching the procedure to a resident, or if a patient shows up in a
condition under which I cannot operate, I can easily reschedule them. Patients get quickly rescheduled,
doctors’ office hours aren’t disrupted, and everyone is happy. The name of the game is customer service.
Peter [Dr. Mikelson] is new and will learn the system like everyone else did. I’m feeling particularly
charitable today. Send Peter my way and we’ll see if we can’t negotiate for some of my scheduled time.”
Dr. Wilkins spoke with Dr. Mikelson last. Dr. Mikelson said, “John, I know I’m the new kid on the block,
but this system is simply unacceptable. Six months ago when I took this position, you and the board
made it very clear to me the importance of building the practice. I’ve done as much as I can, but my
capacity analysis shows that if my growth continues, I’ll need four operating rooms instead of the one I
am currently allocated. The bottom line is the bottom line, and you and I both know the money
Orthopedics brings into the hospital. If I have to beg and plead with Susan Sheehan every time an
unexpected change in my schedule pops up or rely on the grapevine to figure out when the OR is
available, I can’t keep my patients happy. The game has changed, John. Unhappy patients simply go
elsewhere for surgery.”
Dr. Wilkins knew Dr. Mikelson was right. How would he fix the situation in a way that made everyone
happy, including patients, doctors, administrators, and the board of directors? What was the proper
criteria to use: longevity, political clout, fiscal impact? How was he going to allow for emergency
surgeries? How much control did he really want to take away from the physicians in scheduling their
procedures?
Case Study 15-7 What Went Wrong?
Tim Hardwood, CEO of Community Health System, hung up the phone with a heavy sigh. He had just
received the news from Mary Martin, vice president of human resources, that negotiations had stalled
between the health system and the service employees’ union. Mary had told him, “As of now, the 2,000
service employees at our three hospitals are without a contract and threatening to strike. But don’t
worry, Tim. I told the union negotiators that the health system is prepared to handle a strike.”
“A strike!” Tim thought. “The media will have a field day with this! What went wrong?”
Jim Brentward, one of the union negotiators, sat across the table from Mary Martin. Jim told Mary that
his members understood that Community Health System was having financial difficulties because of the
current state of the industry with decreasing reimbursements and increasing regulations, but the union
members were not pleased with the organization’s proposed offer for salary increases and benefits
package over the next 4 years. Jim said, “Unless the health system signs a contract by 5:00 p.m. Friday
with acceptable salary and benefit increases, members of the union are threatening to strike.” He
continued, “The union plans to hold an informational picket on Thursday, and although the union
doesn’t want to strike, it’s a strong possibility. After the informational picket, we will hold a strike vote
and see what our members have to say about the situation.”
Mary was shocked by Jim’s comments. She simply could not believe that Community Health’s service
employees would threaten to strike! Because of her position as vice president of human resources, Mary
knew that the service employees represented by Jim’s union were at the bottom end of the health care
system’s pay scale. These employees included patient transporters, housekeeping, and cafeteria workers.
Mary also knew that the union benefits paid to members during a strike equaled only 50% of the
employee’s weekly salary. Mary felt confident that because they had too much to lose financially, the
employees would never vote to strike. In addition, she knew that Community Health System was
considering outsourcing its dietary departments to Thomson Health care Food Services. If the employees
did strike, although Mary considered that very unlikely, dietary services would continue without
interruption. Knowing this inside information, Mary decided that she wasn’t going to let Jim and the
other union negotiators bully her. Mary told Jim that the health care system would not give in to the
union’s demands and was prepared for a strike.
Explain to Tim Hardwood what went wrong. If you were hired as the mediator, how would you go about
resolving the situation to achieve a win/win agreement?
Case Study 15-8 Healthy Conflict Resolution
“Cindy, please reschedule my afternoon clinic; I am going to be out for the rest of the day,” says Dr.
Jones, a senior physician in a hospital-owned multispecialty group.
“But, Dr. Jones,” Cindy says, while whipping off her telephone headset and turning away from the open
patient registration window, “you are double booked for most of the afternoon because you canceled
your clinic twice this month already. Many of these patients have been waiting more than three months
to see you!”
Jones glances furtively at the waiting room, and already half turned and heading toward the clinic exit,
says, “I’m sure you will be able to smooth things over. Just tell them that I got called to an emergency.”
Cindy has a suspicion that, because the weather is nice, Jones is taking off with a couple of colleagues to
go sailing or play a round of golf. After all, he always sports a darn tan, comes to clinic late, and often
leaves early. Cindy does not relish having to call and reschedule these patients, some of whom have
already been rescheduled at least once in the past couple of months.
Cindy decides enough is enough. She calls her manager and requests a meeting as soon as possible. Her
manager can sense that Cindy is upset and offers to have someone cover for Cindy so that they can talk
privately.
Cindy tells the manager about the situation with Jones that happens “all the time,” and how she is “sick
of it,” and will not “work another day under these conditions.” After calming Cindy down, the manager
promises to bring the matter up with the chief of the department.
To make a long story shorter, suffice it to say that this conflict continues to mushroom to involve several
more individuals (the chief medical officer, the executive director of the clinic, the director of human
resources, and the union representative) before Jones is ever made aware that Cindy has filed a formal
complaint about him. When he is finally confronted, in a meeting with the chief medical officer and the
director of human resources, he is caught completely off guard.
After all, the incident happened several weeks ago, and Cindy did not mention anything to him about it.
They have continued to work together, in his opinion, as if nothing were wrong. He is also surprised to
find out that Cindy has been keeping a tally of the number of times that he has canceled his clinic, left
early, or started clinic late.
Jones goes from astonishment to red-faced anger in a few minutes. It is clear to all that the relationship
between Cindy and the doctor is irreparable. Jones is labeled as a disruptive physician. Cindy is not
welcome in any department because the other physicians are fearful of being targeted. Cindy eventually
resigns, and Jones feels betrayed and unappreciated by his staff and his employer.
If you were the manager in this case, how would you have handled the situation?
Reproduced from Pierce, K. P. (2009, January/February). Healthy conflict resolution. Physician Executive,
35(1), 60–61.
Case Study 15-9 Conflict-Handling Styles
For each of the five scenarios that follow determine the most appropriate conflict-handling style(s).
Scenario One
A radiologist on the staff of a large community hospital was stopped after a staff meeting by a colleague
in internal medicine. On Monday of the previous week, the internist referred an elderly man with
chronic, productive cough for chest X-ray, with a clinical diagnosis of bronchitis. On Thursday morning,
the internist received the radiologist’s written X-ray report with a diagnosis of “probable bronchogenic
carcinoma.” The internist expressed his dismay that the radiologist had not called him much earlier with
a verbal report. Visibly upset, the internist raised his voice, but did not use abusive language.
How should the radiologist handle this conflict with the internist?
Scenario Two
The Family and Community Medicine Division of a large-staff model HMO serves a population that is
ethnically diverse. The senior management team of the HMO, spurred by repeated complaints from
representatives of one racial group, has encouraged the division, all of whose physicians are White, to
diversify. Several Black and Hispanic physicians with strong credentials apply for the open positions, but
none are hired. Weeks later, a young female family physician learns from several colleagues that the
division director has identified her as racist and the obstructionist to recruiting. The comments
attributed to her are not only false but are also typical of discriminatory statements that she has heard
the division chief utter. The rumors about her “behavior” have circulated widely in the division.
How should the young female family physician handle this conflict with the division chief?
Scenario Three
A manager who reports to the vice president for clinical affairs (VPCA) of a tertiary-care hospital hired a
young woman to supervise development of a large community outreach program. During the first four
months of her employment, several behavioral problems came to the VPCA’s attention: (1) complaints
from community physicians that the coordinator criticizes other physicians in public; (2) concerns from
two community leaders that the coordinator is not truthful; and (3) complaints about written reports
about the project that label and blame others, sometimes in language that is disrespectful. The VPCA
spoke several times to the manager about these problems. The manager reported other dissatisfactions
with the coordinator’s performance, but he showed no sign of dealing with the behavior. Two more
complaints come in, one from an influential community leader.
How should the VPCA handle this conflict with the manager?
Scenario Four
The medical school in an academic health center recently implemented a problem-based curriculum,
dramatically reducing the number of lectures given and substituting small-group learning that focuses on
actual patient cases. Both clinical and basic science faculty are feeling stretched in their new roles. In the
past, dental students took the basic course in microanatomy with medical students. The core lectures
are still given, but at different times that do not match with the dental-curriculum schedule. The
anatomists insist that they don’t have time to teach another course specifically for dental students. The
dean has informed the chair of the Department of Anatomy and Cell Biology that some educational
revenues will be redirected to the dental school if the faculty do not meet this need.
How should the dean handle this conflict with the chair of the Department of Anatomy and Cell Biology?
Scenario Five
The partners in a medical group practice are informed by the clinic manager that one physician member
of the group has been repeatedly upcoding procedures for a specific diagnosis. This issue first came to
light 6 months ago. At that time the partners met with him, clarified the Medicare guidelines, and
outlined the threat to the practice for noncompliance. He argued with their view, but ultimately agreed
to code appropriately. There were no infractions for several months, but now he has submitted several
erroneous codes. One member of the office staff has asked whether Medicare would consider this
behavior “fraudulent.”
How should the partners handle the situation with the other physician partner?
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
