Sandra has been the clinical manager in critical care for 10 years. She has noticed that there has been an increasing level of changes in technology and clinical practice in the past 5 years. This new technology has created a different way of treating patients and has called clinical providers to adjust the way in which they deliver care for those patients. Because of the new technology, patients who are more seriously ill are now receiving higher levels of complex and intense care. At the same time, the demand to reduce the length of stay has accelerated as costs have increased and the revenue margin has tightened.

Staff have been reasonably responsive to the demand for change. However, there is a large number of staff members who are finding it difficult to let go of past practices and patterns of clinical behavior. At the same time, there is a large number of staff members who are eager to embrace the challenges of new practices and to incorporate them more quickly on the service. Sandra notes that this diversity of behavior is present in the medical staff as well. Shes finding it hard to determine whether she needs to take a decisive lead and direct the staff to address these new changes or if she should take the additional time required to engage them in dialogue and group process so that together they might determine the best methods of action. Time is of the essence, yet all must be involved.

A group of the critical care staff has been meeting informally over lunch to talk about some of the issues in the service and to discuss matters of concern with regard to changing practice and new patient care demands. They have come up with many creative suggestions and are eager to begin implementing them as soon as possible.

Sandra appreciates their contribution but is beginning to feel as though shes losing control and now is no longer the source of providing direction in her department.

Administration, using a future-search approach, has developed a new strategic plan and set of goals and objectives for the health system. Each department has fully participated in the development of the strategic process and now must begin to incorporate the strategic goals into the operation and activity of the department. Every department must give evidence of advancing the strategic goals of the organization, a part of which is departmental competition for advancing quality and service excellence. Sandra must begin to build this initiative in her department. She is feeling challenged and is unsure how to manage all of this work and still implement new sets of priorities and actions in her department.

Using the information provided in our text and supplemental readings, prepare a three four page paper, (APA format, double spaced, and 12 font) to reflect on the following questions:

What are the two or three most important challenges facing Sandra in this case?
What are the paradoxes Sandra is confronting while trying to provide clinical care and doing the business of the department?
What is the emerging power of the informal system? Has the core group changed the dynamics of leadership and the movement of change?
What is the relationship between the larger organization (larger, complex system) and the department (smaller complex system), and how would you manage the tension between them?
What are the elements of competition and collaboration that are reflected in the departmental goals and staff activities?
What leadership style would best support Sandra in this situation?