Service Journal: Question 11&12 of 15

11)Idenitfy a step in your forcal service business organization where a service employee is required to exercise judgment (divergence). Describe the step and how judgment influences the outcome. What are the types of outcomes and servcie organization responses that you have experienced or would recommed if the employee exercises poor judgment?

Doctors exercise judment in relation to symptoms presented in patient as well as laboatory test results in determining diagnosis and prognosis of patients. Often times chronic illnesses have various modes of treatment. Doctors should discuss these treatments but often times opt for the quick fix. For instance if you complain of chronic back pain a doctor could perscribe several different treatments, such as, physical therapy, surgery, exercise, traction, lifestyle change, or medication. Since a description of these options would require the doctors time and since it is a simple chronic problem the doctor might reach for the presciption drug fix. This ignores the underlying problem which may cause the chronic condition to become an acute emergency. Acute emergencies cost the patient and the hospital system a lot of money. The initial judgment that since it is a common chronic condition and since it is not emergent may lead the physician to make the judgment to diagnose early, quite looking for the cause of the condition, and make a hasty prognosis that requires the use of drugs, which cause the patient to ignore the problem until it worsens and becomes emergent.

12)Imagine that your focal service organization plans on implementing a system which rewards individual employees based on their ability to provide quality. Describe how you would design such a system. What would the quality measures be? How might these quality measures be tied into rewards or compensation? What are factors outside of the control of the employees that would hinder quality assurance (e.g., what are ways that employees might do good work yet achieve results of unacceptable quality—examples)?

Quality is not quality unless the client is willing to pay for it. Does not qualify as a good definition when talking about healthcare. People will pay regardless if treatments are working as in the case of cancer patients which take methotrexate, a poison, as a shotgun approach to kill the cancer, but utimately lose their fight. Can this treatment be deemed high quality given that the outcome was negative. The same can be said for surgeries that fail to correct problems, drugs which have no effect or worse have adverse effects, or despite all known medical interventions the loss of a life; these are failures and as such cannot be categorized as quality. So you cannot tie end success/failure of a process to quality in healthcare because results vary widely from patient to patient. What can be tracked is in process behavior exibited by healthcare professionals, and it impact to customers perceptions on service. Thus customer service surveys need to be administered during the treatment process to track care. The main problem with doing this is asking an unhealthy individual who may be in pain a question about the service they are receiving. I would assume that they may in general give a negative score as their perception of their care correlates to how they feel physically. Another survey that could be used would be an internal survey. This survey would catch much of the background opperations that the patient does not see. This survey would be designed to draw out behaviors and actions that are shown to effect patient care. The final survey would be a personal employee survey. Used primarily to align what is said by patients and coworkers to employees perceptions on quality. Then of course bonus packages, kudos, and other rewards would be tied to the performance of these surveys. As with any survey it may be difficult to attain enough data for it to be relavant, the data may have a skew or a bias that is hidden from the analyst, the survey may not correlate to quality but to assumed quality behavior or actions.