We Need a Better Compensation system1 Kimberly D. Elsbach University of California, Davis Jan Kees Elsbach CEP America into her desk chair with a sigh, being careful to avoid spreading the blood stain on her shirt to the chair fabric.
Finally, another 10-hour emergency room (ER) shift in the books. Only a few notes left to write, and she would be out of hospital and on her way home to bed and six solid hours of sleep before she had to be back to lead tomorrow’s staff meeting. Then she remembered the agenda—review the compensation and bonus system for the ER physicians and get their approval on a new plan. That wasn’t going to be easy. The ER doctors were sharply divided in their preferences for a compen sation system. Some wanted a system that kept a communal atmosphere in the group, where everyone worked equally hard and was paid accordingly. Others felt like they were D r. Padma Singh, Director of Emergency Medicine at Westlake Hospital, collapsed 1This fictional case is based on the second author’s 20-plus years of experience working in actual emergency rooms in five large cities throughout the United States. carrying more of the load and should be compensated for that. It was clear from looking at monthly records that some doctors routinely treated more patients than others. Dr. Singh wanted the system to motivate the group rather than add dissatisfaction. Padma groaned and buried her head in her hands. She now doubted that she’d be get ting a good night’s sleep after all. She had three alternative plans to present to the physi cians in the morning, and she wondered if they would accept any of them. Background on Westlake Hospital and the Emergency Physicians of Sacramento Group Westlake Hospital is a privately owned, 162 bed, full-service hospital located in Sacramento, California. Westlake serves a mostly working-class patient population who rely on government insurance such as MediCal or Medicare. The hospital staffs its 29-room ER with doctors from a privately owned, physicians group called Emergency Physicians of Sacramento, or EPS. EPS has 20 physician members who staff their sister hospital, Eastlake, in addition to Westlake. Thus, EPS is a service provider for Westlake Hospital, and Padma Singh and the other 19 EPS physicians are not employees of Westlake Hospital, but employees of EPS. Working in the ER at Westlake When ER doctors work at Westlake Hospital, they work in teams of two. One doctor is the “triage doctor,” who sees all patients in a “triage room” shortly after they arrive, and the second doctor is the “follow-up doctor” who sees patients, who are deemed in need of a higher level of care, in actual ER treatment rooms. The triage doctor interviews and briefly interacts (approximately three minutes) with all new patients after they have checked into the ER. If the triage doctor determines that the patient needs to be seen by the follow-up doctor, he or she will pre-order tests or treatments (e.g., blood tests, urine te
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