Question

Adapted and shortened version of "Conserving Blood During Cardiac Surgery at Huntington University Hospital" Case Study from MIT Sloan School of Management

Key Question: Which approach from the Hershey & Blanchard Situational Leadership model would you recommend Surgical Director Young utilize and why? Second, let's pretend Surgical Director Young has the characteristics to be a transformational leader. Which aspect of transformational leadership should Dr. Young especially focus on in this situation?

Case Study:

Patients who undergo cardiac surgery often require a blood transfusion or other blood products. In order for surgeons to work upon or inside the heart, certain parts of the heart or great vessels surrounding it needed to be opened and then repaired with suture material. Opening a chamber of the heart disrupted its hermetic seal and permitted blood to spill out and into the surrounding space. While bleeding was undesirable for obvious reasons, restoring blood via transfusions is not a panacea. According to a 2006 study published in the Annals of Thoracic Surgery, a cardiac patient who received a blood transfusion after an aortic valve replacement or a coronary artery bypass grafting had a 30% lower chance of survival at six months and a 50% lower chance at 10 years. The 10-year survival rate without a transfusion was 90%.

On average, 49% of patients in the United States who underwent an AVR or a CABG required a blood transfusion. At Huntington University Hospital (HUH), where 500 patients underwent an AVR or CABG annually, the percentage of patients who received blood transfusions in 2011, 2012, and 2013 was around 71%. This was happening at a time when the Affordable Care Act of 2010 was forcing hospitals to provide quality care in a cost efficient way.

Dr. Frank Young became HUH's Surgical Director in 2011. Prior to joining HUH, he spent two years as a cardiac surgeon at one of the world’s top cardiac care hospitals where medical teams carried out over 4,000 open heart operations a year. Huntington University hired Young to rejuvenate the hospital's heart transplantation program where the number of patients coming in was on the decline and outcomes were unsatisfactory. One medical survey conducted in 2013 ranked HUH #39 for cardiology and heart surgery, giving it very low scores when it came to patient safety and success in preventing major postsurgical bleeding. Despite the poor score, patient safety was a critically important value at HUH. Every month, an email was sent out to the entire hospital staff recognizing specific employees for making a meaningful contribution to patient safety.

Director Young wanted to help bring down the hospital's transfusion rate by leading a blood conservation project involving the medical teams that worked together during the intra- and postoperative phases. The goal was to reduce the hospital’s blood product utilization during cardiac surgery and after by two-thirds within one year, by the end of 2014, thereby bringing transfusion rates down to the national average and resulting in annual cost savings of $2.5 million. More importantly, it would save the lives of an additional 125 people per year over 10 years.

Young knew he faced an uphill battle in convincing his the surgeons and the medical teams that accompanied them during surgeries to make changes to their surgical routines. Autonomy was critically important to physicians and he was attempting a professional intervention of sorts. Furthermore, he was a new arrival to HUH, especially considering some of the surgical team had spent their entire careers there. In addition, every cardiac operation involved a 20-person functional team, which included the cardiac anesthesiologist, perfusionist, cardiac surgeon, operating room (OR) nurses, intensive care unit (ICU) physicians, physician assistants, and fellows and residents.

Could you please include an analysis of the case study?

Answer 1

Could you please include an analysis of the case study?

In the given case study, an elaboration has been made abou the failure of procedures or the loop hole in the procedures carried out at the time of cardiac surgeries that led to a decrease in fame and ranking of the HUH, along with a decrease in the patient safety, which led to these consequences. There has been a shift in management, with a new director, Dr. Frank Young, who attempted in identifying these loop holes and correcting them, but the issue was about the autonomy of the physicians who would want to or not want to implement the newer techniques.

Which approach from the Hershey & Blanchard Situational Leadership model would you recommend Surgical Director Young utilize and why?

The leadership model to be used in this scenario would be the delegating style, in which the physicians would be able, willing as well as confident in the decisions made would be turning over decisions..

Second, let's pretend Surgical Director Young has the characteristics to be a transformational leader. Which aspect of transformational leadership should Dr. Young especially focus on in this situation?

He should be focusing on making the physicians agree with the newer ways on their will so as to make them understand that there have been issues with the present surgical procedures and that these procedures are affecting patient safety.