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September 06, 2007



I am a RN and have worked at a university hospital system since 1987. I now work as a physician extender/case manager for a busy oncologist. We have recently had a change in the outpatient administrator. He is applying pressure to my clinic manager as well as the clinical director concerning finances; specifically overtime pay. Having worked at this organization for an extended period, I have watched the same series of actions take place with each new administrator:
1. The nursing budget is looked at as the priority place to cut cost.
2. The experience nurses become frustrated, angry, and then leave.
3. The complaints from patients rise to a crescendo.
4. Administration resends all previous cost cutting measures in the crisis rush to get staffing to a level where patients will be cared for properly.

After following chain of command, speaking with my clinic manager and clinical director, I had hoped to be able to share my past experiences with the new administrator. Unfortunately the meeting was cancelled. Is there a better way to be able to communicate with the hospital administrators? Am I out of line in wanting to be proactive to prevent the same series of bad decisions happening again? If you have any suggestions for me, including but not limited to "leave it alone" I would be most grateful for any and all suggestions.

Kenneth H. Cohn

Dear Michelle,

Thanks for your heartfelt comments. You have every reason to take a proactive approach. The quality of patient care is at stake. Multiple ways for you to connect with the administrator include:
- your willingness to share with him ways that oncology patients may differ from other outpatient settings, such as need for urgent visits based on unforseen (but trackable) complications; if you have data over the past year that show trends, you two could discuss it
- your and other nurses' ability to show him where processes are inefficient, resulting in increased staff time, where streamlining could save you and others time and save him money;

Improving processes is a win-win that can improve quality and cut costs at the same time; it is as simple as putting every step of a process on a large post-it note and putting the notes on a wall for everyone to see and comment on:
- how does the process work
- how should it work
- ideally, how could it work best

Clearly, all of the above ideas will only work if the new administrator feels that you are invested in his success and vice-versa. It takes time to build transparency and trust, especially in view of what you have experienced in the past.

Let's open up the forum to others in similar situations:
- What works
- What are the dividends for Michelle of adopting a proactive approach

Michelle is looking for answers. Please, offer her your practical insights and give her reason to hope for a better future.

Kenneth H. Cohn

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