Case Study: La Familia

La Familia is a family practice clinic located outside of a major city that takes care of the poorer, primarily Hispanic portion of the community. The executive director discovers a problem the elderly patients in the clinic might be experiencing. This case study examines aspects of the plan the executive director devised in response to this problem.

Define the problem occurring within the health care clinic.

Wagner and Niles-Yokum (2014) relayed a case about an executive director of the clinic who discovered, in meeting the patients in the facility and through discussions with fellow staff, bruising on their geriatric patients. The staff decides to follow up and questioned the children who have abuelas (grandmothers) in their home. The staff, to their dismay, discovered from the responses that the bruising they are seeing upon their geriatric patients could be a result of domestic violence rather than from falls, another common problem affecting the elderly.

Describe the legal and ethical issues presented within the case study and discuss the leader’s role in addressing these issues.

In the case Wagner and Niles-Yokum (2014) described, the healthcare workers are ethically and legally obligated to report incidences of elderly abuse, and ethical issues are on par with the legal issues in this instance. Professionals must use their ethical foundations, personal and professional, in order to make decisions that are right and wrong given the context of the situation. The director knows how important family is in the Hispanic community, yet many if not most of the abusers are family members, and the elderly patients are most likely dependent upon the abusers financially and physically. Involving the law can erode the trust they have established in the community. Moreover, the healthcare workers have to worry about backlash effects if it is revealed that their elderly patients are suffering physical abuse at the hands of their family members, and the abuse against the victim could worsen. Yet, the healthcare workers in the facility have an important role to care for their elderly patients, who are many times not in a position to protect themselves and have limited physical and financial options, and a legal obligation to report incidences of abuse. Moreover, the clinic can leave itself open to lawsuits from other family members if the abuse had been documented and known about but went unreported. The leader must address this complicated issue with sensitivity while meeting the clinic’s legal obligations to report abuse while maintaining the trust they established within the community. The executive director also has to, in her role as leader, support the staff as they instill a new program to follow up on elderly injuries.

Discuss the leader’s plan for addressing the issue outlined in the case study. What are the pros and cons of her “to do list”?

The executive director had decided on a protocol to help families in need address elderly abuse. This protocol helps the healthcare workers in the facility collaborate with Adult Protective Services to address the problem of elderly abuse within their geriatric patients. In order to put her plan into motion, she decided upon four tasks. She would call Adult Protective Services to do a seminar to educate the healthcare professionals on her staff. She would appoint two or three staff members to create and run the team to address the problem of elderly abuse. She would have the patient educator to create educational materials for patients. Last, she would have a staff meeting to discuss the protocol the facility should follow to identify at-risk patients and family intervention.

The executive director is taking into consideration her staff members and valuing their contributions as experts and team members. However, she is not conducting a cost analysis of the project and securing the funds needed to finance the materials of the project. Also, her approach lacks research into the problem or the best solutions for the problem. The director’s plan also lacks the creation of a system of accountability. A reporting system should be created in order to ensure that the steps they are taking to address the problem are successful, or if other measures need to be added or subtracted to make their new system more efficient.

What might be some implications for the clinic and the community in implementing an elderly abuse intervention program?

The clinic needs to focus upon family intervention rather than incarceration. Incarceration may not be the best solution for all cases because it can take away the elderly patient’s primary source of income and physical care, as well as divide the family and can in turn affect the entire family. Also, as the American Psychological Association (APA) (2013) stated, the clinic should not confront abusers themselves unless they have the permission of the patient and the clinic is in the position to assume full responsibility for the safe care of the patient, such as moving the patient to a facility. Also, the clinic must keep in mind that many caregivers, especially from lower economic statuses as this clinic serves, are more apt to get burned out. The clinic’s focus should be upon providing support to the elderly client as well as the family in charge of the care of the patient. In this manner, the clinic will maintain the trust of the community. If the clinic loses the trust of the community, the elderly patients might be denied medical for fear of reprisal and prosecution.

Describe a leadership style that may benefit the situation and explain how the clinic manager could utilize each of John Kotter’s 8 Step Process for Change in facilitating the changes within the clinic.

According to Mind Tools (2013), the leader must decide what role to play to support the staff through installing changes or completing tasks and what styles to borrow from in order to most efficiently support the project to completion. It seems for this case, the best leadership skills the executive director of La Familia could borrow from in terms of styles are democratic, since the healthcare workers are highly trained and educated individuals and mutual respect must be fostered, task orientation to ensure the tasks for installation of the program are put into place and the clinic is compliant with legal requirements, and transformational aspects of leadership styles. In borrowing from these types of leadership skills, the executive director will be able to utilize the positive aspects of transformational leadership while addressing the possible pitfalls of the style, which is a possible lack of attention to detail to the project. In borrowing from these different styles of leadership, the executive director will be able to inspire each person to practice and adhere to the implementation of the new program through mutual respect while ensuring that each person is responsible for task completion.

The executive director of the clinic can utilize John Kotter’s 8 Step Process for Change (Kotter International, 2012) in the following manner. From what was relayed in the case study (Wagner & Niles-Yokum, 2014), a sense of urgency was already established when the executive director researched the problem with the staff members. Since the staff members will be in charge of assessment and intervention, the executive director did appoint a few staff members to head up the team. The executive director needs to provide the team with how the implementation of the new elder abuse prevention protocol will affect the practice and what changes are expected of the staff members. The executive director can use photographs documenting the bruises of their elderly patients as a way to convey a sense of urgency, immediacy, and resolve the staff’s intentions as a unified team to combat the problem. Removing or preventing obstacles can facilitate the creation and installation of the prevention protocol. The executive director can do this in choosing the team members in charge of the clinic’s task force wisely, that seem to have a managerial style that facilitates change. The executive director should also plan the project in terms of short-term and long-term goals so the team can measure and realize their progress. Once short-term goals are achieved, the progress needs to be continued long-term. Some strategies for ensuring this is monitoring progress and making adjustments along the way, such as bringing in other employees to participate, and motivate the employees to prevent complacency. The last step is to foster a cultural change in the clinic. The executive director can achieve this by reporting the results of their efforts to the staff, so the staff believes that their efforts truly have made a difference. Believing in the system will create the cultural changes needed to ensure their adult abuse prevention protocol will become an integrated part of their system of practice.

References

American Psychological Association (APA). (2013). Elder abuse and neglect: In search for solutions. Retrieved from http://www.apa.org/pi/aging/resources/guides/elder-abuse.aspx?item=1

Kotter International. (2012). The 8-step process for leading change. Retrieved from http://www.kotterinternational.com/our-principles/changesteps

Mind Tools (2013). Leadership styles: Choosing the right style for the situation. Retrieved from http://www.mindtools.com/pages/article/newLDR_84.htm

Wagner, D.L., & Niles-Yokum, K. (2014). A community-based health care clinic takes on the complicated issue of abuse. In S.B. Buchbinder, N.H. Shanks, & D. Buchbinder (Eds), Cases in health care management (pp.261-264). Burlington, MA: Jones & Bartlett Learning.