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CASE 13:

BAD IMAGE RADIOLOGY DEPARTMENT

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Briana Marcantonio

Dr. West

HADM 509: Administrative Issues

The University of Scranton

19 March 2018
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CASE ANALYSIS #13

1. Briana Marcantonio.

2. Case #13, “Bad Image Radiology Department,” and Monday, March 19, 2018- 7:20 p.m.

3. Summary of the Case:

MacMillan Hospital is located in the southeastern United States. It was named after the

successful lumber and hardware merchant, Abner MacMillan. There have been many renovations

to the hospital and was eventually licensed for 350 beds, but only operated 250. The MacMillan

Hospital offers all primary and secondary acute care inpatient services, along with a few tertiary

services. Annual outpatient admissions exceed 80,000 and has over 1,000 FTEs. MacMillan has

2 other competitor hospitals in the same area, but MacMillan has more advantages. Macmillan

has contracts with six different physician groups that provide different services. There is a split

between supervision and employment which resulted in a matrix type of organization.

Macmillan Hospital is governed by a 21-member board of trustees nominate and select

replacement trustees. Trustees serve 3-year terms and may be re-nominated for two additional

terms. The hospital CEO is an ex officio member and has no vote. The board meets monthly and

the seven committees meet quarterly. The board chair is Harriet Buchanan, she just started her

second term as chair. The board is composed of different stakeholders of different ages and

backgrounds. The board has been very successful overall. The PSO committee makes

recommendations through the executive committee after it reviews credentialing. There are 920

physicians on MacMillan’s PSO, 200 which are active. The PSO bylaws define “active” as

physicians who admit five or more inpatients per year.

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The CEO, Jack Gargon was appointed 15 years ago. His reputation in the hospital is that

he is a capable and technically proficient manager who gives his management team a wide range

in decision making. Gregory Halton is Gargon’s VP for clinical services. Gargon failed to

address the issue with Goodview Medical imaging and chief of medical imagine, Harold

Goodview. Goodview was a very bad seed in this organization and the quality of services in his

organization were unacceptable. Eventually, MacMillan Hospital terminated their contract with

the radiology center. Then Goodview sued MacMillan Hospital for conspiracy to deprive

Goodview of his business and reputation of medical imaging. MacMillan Hospital won the court

case, but then another lawsuit was filed by a patient’s estate due to an incorrect diagnosis and

medical negligence.
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CASE ANALYSIS #13

4. 15 Most Important Facts/Factors in the Case:

 1. MacMillan Hospital was located in southeastern United States in the decade following

the Civil War. MacMillan Hospital was named after Abner MacMillan and was renovated.
 2. MacMillan was licensed for 350 beds, but only operated at 250 beds, which had an

average occupancy rate of 75%.

 3. MacMillan Hospital offers all primary and secondary acute care inpatient services,

along with a few tertiary services.

 4. Annual outpatient admissions exceed 80,000 and has more than 45,000 admissions in

the ER department. The hospital has over 1,000 FTEs.

 5. MacMillan has 2 competitor hospitals in the area.
 6. MacMillan has contracts with six different physician groups that independently

provide services, the most important one being the radiology imaging center.
 7. MacMillan Hospital is governed by a 21-member board of trustees and the board is

self-perpetuating. The CEO has no vote.

 8. The PSO sees itself as a partner in the full range of hospital activities.
 9. The board committee included executive, PSO, HR, strategic planning, budget and

fiscal, quality evaluation and nominating.

 10. The CEO, Jack Gargon was appointed 15 years ago and holds a master’s degree. He

has more than 25 years of senior-level experience.

 11. Gargon eliminated middle management which caused significant issues among

surviving middle managers who had seen friends and colleagues fired.
 12.Gregory Halton was VP of clinical services. He is administratively responsible for the

department of medical imaging, which is the radiology department.

 13. The chief of medical imaging is Harold Goodview, M.D. who is a radiologist.
 14. MacMillan and Good Views, LLC signed for a 5-year extension of their basic

contract.
 15. The VP/PA responsible for clinical staff supervision but, the position had been vacant

for last 6 months.

 16. Goodview has had difficulty keeping radiologists employed in his company and in

staffing the department.

 17. The chief radiographic technologist, Sally Lebeau, raised four problems:
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CASE ANALYSIS #13

o A. Fewer radiologist and higher volume

o B. Constant turnover rate of radiologist
o C. Goodview did more and more work
o D. Goodview ordered cable connection without knowledge of senior

management.
 18. Dr. Leipzig raised a question about the speed of his readings especially on

mammograms, Goodview said that reading mammograms is so simple a first-year

medical student could do it.

 19. To check Goodview’s reading, Leipzig reread 100 randomly selected mammograms

and found several that warranted follow-up studies, including repeat mammograms and

fine needle aspirations. He ordered them without telling Goodview.

 20. Lebau had a meeting with Halton and she commented that the radiology center has

poor staff morale, low patient satisfaction, high turnover of radiologists, and Goodview’s

continuing bad behavior were causing a great deal of stress.

 21. Halton met with Gargon and they were unsure how to proceed about the radiology

center and had no plan of action.

 22. The board decided to terminate the contract and sent 30-day notice for termination of

contract.
 23. Ameila Tendo, a housekeeper of MacMillan Hospital, went to the radiology center for

a free mammogram screening because she found a small lump on her breast- Goodview

told her it was a calcium deposit.

 24. The first lawsuit was filed, and the TRO was vacated.
 25. The second lawsuit involved Ms. Tendo, Goodview read it incorrectly and she was

diagnosed with stage 3 breast cancer that metastasized to her lung and she died 3 months

later. Her estate sued Goodview, his company and MacMillan Hospital for medical

negligence.
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CASE ANALYSIS #13

5. Most Important Health Administration Problem/Issue:

 The most important health administration problem/issue to be solved in the case would be

MacMillan Hospital’s administration and governing board has failed to monitor the

clinical services (radiology) and support services to achieve high quality delivery of care.
 Other Secondary Problems in the Case:
o 1. Halton can be stubborn and occasionally peers have questioned his judgement.
o 2. VP/PA position has been vacant for 6 months, despite efforts to recruit a

replacement for the previous incumbent who retired.

o 3. Goodview’s speed of looking at radiology images.
o 4. Rumors that union organizers have talked to employees.
o 5. The split between supervision and employment in the outsourced physician

groups result in a matrix type of organization, but divides employee loyalty, blurs

line of authority and reporting, violates the unity of demand.

o 6. Gargon’s elimination of middle management caused significant grumbling

among surviving middle managers who had seen friends and colleagues fired.
o 7. Goodview has had difficulty keeping radiologists employed in his company and

in staffing the department.

o 8. In Good View there are 4 problems:
 Fewer radiologists, constant turnover, Goodview does most of the work

himself, and Goodview ordered a cable connection to watch the stock

market without telling anyone

o 9. Goodview’s overall behavior.
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o 10. Leipzig rereading the scans and sending them for follow-ups behind

Goodview’s back.
o 11. Contract termination:
 Lawsuit 1- Goodview filed suit against MacMillan for breach of contract

and defamation
 Lawsuit 2- Ms. Tendo’s estate sued Dr. Goodview, Good Views Medical

Imaging, and MacMillan Hospital for medical negligence

6. My Recommended Solution for the Case:

6a. Three Possible Realistic Alternative Solutions for the Most Important Problem:
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 Solution #1) Create a quality team or a quality assurance employee, thus

employees and clinical staff positions can be assessed on a quarterly basis.

o Each physician who had privileges at Macmillan must pass through a re-

evaluation of services they provide. When the assurance team assesses a

pass or a fail, then they could fire the physician.

 Solution #2) Fill the empty position of the VP/PA.
 Solution #3) The MacMillan board of trustees and the CEO should be

restructured. Communication should be increased, and problems should be

addressed immediately.

6b. Criteria to Evaluate Possible Alternative

 Solution #1) Create a quality team or a quality assurance employee, thus

employees and clinical staff positions can be assessed on a quarterly basis.

o Needed resources, cost-effectiveness, ability to implement, and ethical

considerations.
 Solution #2) Fill the empty position of the VP/CS.
o Needed resources, cost-effectiveness, and qualifications.
 Solution #3) The MacMillan board of trustees and the CEO should be

restructured. This would solve the authority and communication problem. Give

incentives for good behavior as well.

o Ability to implement, side effects, and ethical consideration.

6c. Evaluation of the Possible Alternative Solutions (6a) Using the Criteria (6b):

 First Possible Solution: Create a quality team or a quality assurance employee,

thus employees and clinical staff positions can be assessed on a quarterly basis.
o Needed resources/qualifications- Using the correct tools to find a

qualified quality team/assurance person.

o Cost-effectiveness- Ensuring that the budget can handle to pay a salary to

the new quality team.

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CASE ANALYSIS #13

o Ability to implement- Ensuring that the quality team will be able to

implement this and get everyone on board with the new changes.
o ACHE Ethical considerations- Implementing ACHE ethics and code of

conduct into the employees of MacMillan Hospital.

 Second Possible Solution: Fill the empty position of the VP/CS.
o Needed resources- Using the correct tools to find resumes.
o Cost-effectiveness- Ensuring there is enough money to fit into the budget

for the new person’s salary.

o Qualifications- Ensuring the new person is highly qualified, educated,

and has experience in this type of organization.

 Third Possible Solution: The MacMillan board of trustees and the CEO should

be restructured. Communication should be increased, and problems should be

addressed immediately.
o Ability to implement/timing- Ensure restricting plan in implemented

soon and correctly.

o Side effects- The board and CEO may not be too fond of this idea and

may fight it. Ensure that the board and CEO are engaged enough so no

issues occur.
o Ethical consideration- Implementing ACHE ethics into the board.

6d. My Recommended Solution for the Problem:

 As an MHA graduate student, future hospital administrator, and based from the

criteria provided, the solution I would chose is solution number one: “Create a

quality team or a quality assurance employee, thus employees and clinical staff

positions can be assessed on a quarterly basis.” I think this is a realistic solution

and would solve most of the issues at MacMillan Hospital. The quality assurance

team could monitor the quality of service provided by the active employees and
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CASE ANALYSIS #13

the locum tenes physicians. Thus, management could ensure the quality provided

by the physicians were up to standards.

7. MHA Tools:

 ACHE Ethical considerations- Implementing ACHE ethics and code of conduct into

the employees of MacMillan Hospital. The purpose of the Code of Ethics from ACHE

is to serve as a standard of conduct for members. It contains standards of ethical

behavior for healthcare executives in their professional relationships. These

relationships include colleagues, patients or others served; members of the healthcare

executive's organization and other organizations; the community; and society as a

whole.
 Disciplinary actions- Used when board members misbehave and try to create issues in

the organization.
 Root cause analysis- Could be used to identify the root causes of faults or problems

and figuring out a way to solve them.

 Behavior management- Uses behavior contracts to prevent poor behavior and

disruptive behavior in the workplace.

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CASE ANALYSIS #13

 Quality assurance model- This model will prevent mistakes or defects in the

organization and will avoid problems when delivering solutions or services. It will

also make sure quality service and delivery of care is up to standard.

Case Questions:

 1. Identify the issues in the case.

o Answered in question 6.

 2. Prepare a time line of major events in the case. Determine the points at which

intervention by hospital administration or the board might have prevented the problems in

medical imaging from developing as they did. For each intervention point, outline the

intervention that should have been taken.

o When Lebeau provided the four problems with Goodviewthen Halton’s efforts

to disconnect the cable connectionGoodview’s complaints to the CEOwhen

Gargon ignored Leipzig’s investigationLeipzig’s resignationGargon and Halton

tried to resolve tissues with Goodviewspots were available for new

radiologistscontract terminatin letter was sentobtained the TRO orderMs. Tendo

had a free mammogram in OctoberMacMillan was sued and won the caseMs.

Tendo found out she had breast cancer and died three months laterMs. Tendo’s
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estate filed a lawsuit against MacMillan, Goodview, and Good View Medical Imaging

for medical negligence.

 3. What is the role of hospital executives in monitoring quality and intervening, as

needed, in the delivery and/or quality of clinical services?

o The role of hospital executives in monitoring quality and intervening, as needed,

in the delivery and/or quality of clinical service are: make more efforts to improve

quality and patient satisfactions, create benchmarks for services, and take

administrative decisions seriously in regard to the other clinical contracted

departments.

 4. Identify points at which hospital administration should have intervened to lessen the

probability of Dr. Goodview’s failure to diagnose Ms. Tendo’s breast cancer.

o The hospital administration should have intervened to lessen the probability of Dr.

Goodview’s failure to diagnose Ms. Tendo’s breast cancer at certain points, for

example: when Dr. Goodview read her mammogram, lack of radiologists, the high

turnover rate in the department, and Dr. Goodview’s poor behavior and attitude

towards these issues and his employees.

 5. What steps should be taken by MacMillan Hospital to resolve the lawsuit brought by

Ms. Tendo’s estate? Is an apology part of an appropriate response?

o Identify the time period of when Goodview took the mammogram and analyzed

it. Then make sure that you state that the contract termination has already been issued.

Since the hospital and Good View were liable, I would create an apology letter to give

and speech to say in the court to Ms. Tendo’s family and friends. Lastly, then I would

try to settle the court case.

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CASE ANALYSIS #13

 6. What actions, if any, should be taken against Messrs. Gargon and Halton? Who should

take them?
o Personally, I think the board should take actions about Halton and Gargon.

Gargon failed to support Halton and Halton was not ready to take on the

responsibility of the physician outsource services. Since Halton was only 27 years

old, he lacks experience and professionalism; he also may be more shy than other

professionals. Proper authority is required in order to deal with disruptive issues and

people, such as Goodview.

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Reference

Darr, K., Farnsworth, T.J., & Myrtle, R. C. (2017). Cases in health services management (6th ed).

Baltimore, MD: Health Professions Press, Inc.