# data[].attributes.headline
Excellent comment, Tapfumanei. Your words support the increasing need for greater intrasectoral collaboration as well as informed decision making on the part of the consumers of health care in your community. 

# data[].attributes.subject
Excellent comment, Tapfumanei. Your words support the increasing need for greater intrasectoral collaboration as well as informed decision making on the part of the consumers of health care in your community. 

# data[].attributes.body
Sue

# data[].attributes.headline
Thanks Michelle. Your words reflect the notion that organisations also have social responsibilities that extend beyond their physical boundaries and that organisational decisions/actions can impact on the wider community.

# data[].attributes.subject
Thanks Michelle. Your words reflect the notion that organisations also have social responsibilities that extend beyond their physical boundaries and that organisational decisions/actions can impact on the wider community.

# data[].attributes.body
Sue

# data[].attributes.headline
Excellent demonstration of critical thinking, Lily

# data[].attributes.subject
Excellent demonstration of critical thinking, Lily

# data[].attributes.body
Sue

# data[].attributes.headline
The very last thing I would do would be to shut the Rehab centre.  By doing this the healthcare facility will lose a significant quota of community good will and this may reflect back  to them in the form of low patient occupancy  - with the community choosing to be treated in a facility that it perceives to be fulfilling their best interests.  I would redevelop the rehab centre and offer consumer insight into this project.  Offer it as an opportunity for the community to determine the model of care that they want  - It would serve as a great marketing tool and engages the community which inturn should inspire loyalty to that organisation.  I would offer rehab services to the competitor (perhaps at a slightly elevated price!!) in an endeavour to control overheads then through profitable financial governance I would invest in the upgrade of facilities and invest further in the community.

# data[].attributes.subject
The very last thing I would do would be to shut the Rehab centre.  By doing this the healthcare facility will lose a significant quota of community good will and this may reflect back  to them in the form of low patient occupancy  - with the community choosing to be treated in a facility that it perceives to be fulfilling their best interests.  I would redevelop the rehab centre and offer consumer insight into this project.  Offer it as an opportunity for the community to determine the model of care that they want  - It would serve as a great marketing tool and engages the community which inturn should inspire loyalty to that organisation.  I would offer rehab services to the competitor (perhaps at a slightly elevated price!!) in an endeavour to control overheads then through profitable financial governance I would invest in the upgrade of facilities and invest further in the community.

# data[].attributes.body
Michelle

# data[].attributes.body
With no personal experience in this form of leadership role and limited leadership experience in the work place I do not have much experience to fall back on.

I would want to keep the rehabilitation facility open especially as it is locally provided and populated and is not otherwise available in the community.

My initial response would be to develop a forum of discussion, perhaps a series of meetings to openly and honestly discuss this problem of finances and employment with the employees, volunteers and on occasion clients. I would express the concerns and ask for reflection and ideas. Discussion topics may include fundraising activities, sponsorship, employee volunteering and pay.

I would also create a business plan based on an assessment of costs within the facility as a whole. I would want to explore where dollars could be saved. Cutting down on night time use of electricity and using generic brands of medicine, food, cleaning agents and cleaning companies, as well as toiletries can make a large difference in costs for an organization.

It is important for me that the team was on board. If there is little engagement i.e. workers wanting to retire or the main facility members being unwilling to participate then I would more seriously consider downsizing or closing the facility. However if the members of the discussions are engaged and driven to maintain this facility I would do everything I could to keep it open and promoting best health outcomes.

Caeli

# data[].attributes.headline
The situation presented in the article by Carlopio and
Andrewartha presents a common ethical dilemma in healthcare where allocation of
resources is an issue. I do agree with most of the options provided in other
readings on this forum and personally think other options should be exhausted
before closing down the rehabilitation unit such as engaging the community
through seeking their thoughts and ideas, collaboration with the rival
healthcare provider to share the service or even incorporating the rehabilitation
service within the main hospital thereby saving jobs and ensuring the service
remains available.

Unfortunately, I work in a private health organisation within
a regional city and have witnessed a similar scenario where my organisation was
under significant pressure in trying to balance equitable distribution of
services with very limited resources. Many people have dropped their private
healthcare due to financial difficulties and as a result the bulk of patients
in our city have chosen to go to the public hospital. Consequently, our patient
numbers have dropped and as a result the hospital is facing a dilemma in provision
of appropriate, equitable and quality healthcare on a limited budget. On a
positive note, we have not reached a stage where a department needed to be shut
down and one of the strategies used by management was collaborating with the
public hospital to identify individuals with private and seeking their choice
on whether to go private or public and redirect them appropriately.

# data[].attributes.subject
The situation presented in the article by Carlopio and
Andrewartha presents a common ethical dilemma in healthcare where allocation of
resources is an issue. I do agree with most of the options provided in other
readings on this forum and personally think other options should be exhausted
before closing down the rehabilitation unit such as engaging the community
through seeking their thoughts and ideas, collaboration with the rival
healthcare provider to share the service or even incorporating the rehabilitation
service within the main hospital thereby saving jobs and ensuring the service
remains available.

Unfortunately, I work in a private health organisation within
a regional city and have witnessed a similar scenario where my organisation was
under significant pressure in trying to balance equitable distribution of
services with very limited resources. Many people have dropped their private
healthcare due to financial difficulties and as a result the bulk of patients
in our city have chosen to go to the public hospital. Consequently, our patient
numbers have dropped and as a result the hospital is facing a dilemma in provision
of appropriate, equitable and quality healthcare on a limited budget. On a
positive note, we have not reached a stage where a department needed to be shut
down and one of the strategies used by management was collaborating with the
public hospital to identify individuals with private and seeking their choice
on whether to go private or public and redirect them appropriately.

# data[].attributes.body
TAPI

# data[].attributes.headline
As someone
with little to no management experience, it has taken me some time to decide
what I would do.

My ideal
would be to keep the satellite rehabilitation unit and the health care facility
open as both the facility and rehab unit are clearly important for the
community and staff. I am aware that to keep them open, they need to be
profitable. My manager has made me very aware of budget constraints in the
facility I work in, so I am concerned as to how my budget would allow me to
keep both these facilities open.

I believe
the most important thing is to improve the quality of care being delivered, so
I think it would be best to update the technology and processes, therefore
having to close the rehab unit. My hope that with improved quality care, the
health care facility will become profitable, and will be the preferred facility
in the community. With the profits, perhaps the rehabilitation facility could
be reopened.

However, before
closing the rehab unit, I would approach stakeholders, the community and staff
to determine if there was a way of fundraising money to keep the unit open. Or
as mentioned by Dallas (on this shareboard), I would approach the rival
facility, to see if there was a way of working together to keep the rehab unit
open. 

# data[].attributes.subject
As someone
with little to no management experience, it has taken me some time to decide
what I would do.

My ideal
would be to keep the satellite rehabilitation unit and the health care facility
open as both the facility and rehab unit are clearly important for the
community and staff. I am aware that to keep them open, they need to be
profitable. My manager has made me very aware of budget constraints in the
facility I work in, so I am concerned as to how my budget would allow me to
keep both these facilities open.

I believe
the most important thing is to improve the quality of care being delivered, so
I think it would be best to update the technology and processes, therefore
having to close the rehab unit. My hope that with improved quality care, the
health care facility will become profitable, and will be the preferred facility
in the community. With the profits, perhaps the rehabilitation facility could
be reopened.

However, before
closing the rehab unit, I would approach stakeholders, the community and staff
to determine if there was a way of fundraising money to keep the unit open. Or
as mentioned by Dallas (on this shareboard), I would approach the rival
facility, to see if there was a way of working together to keep the rehab unit
open. 

# data[].attributes.body
Lily

# data[].attributes.headline
Good thoughts, Jessica. Articulating ideas through a Business Plan can help to identify the issues and clarify goals. Would your BP include a Mission and/or Values Statement. If so, what might these contain/reflect?

# data[].attributes.subject
Good thoughts, Jessica. Articulating ideas through a Business Plan can help to identify the issues and clarify goals. Would your BP include a Mission and/or Values Statement. If so, what might these contain/reflect?

# data[].attributes.body
Sue G

# data[].attributes.headline
Excellent, you have demonstrated the importance of 'how rather than only 'what' as well as the importance of data gathering and evidence-based decision-making.

# data[].attributes.subject
Excellent, you have demonstrated the importance of 'how rather than only 'what' as well as the importance of data gathering and evidence-based decision-making.

# data[].attributes.body
Sue G

# data[].attributes.headline
Good work. You have taken a 'greater good' perspective which offers an excellent argument for the dilemma. What do others think?

# data[].attributes.subject
Good work. You have taken a 'greater good' perspective which offers an excellent argument for the dilemma. What do others think?

# data[].attributes.headline
Good work, Nicola, sometimes good ideas are generated from people who might consider that they are inexperienced whereas in fact, they can provide insight through 'fresh eyes'. 

# data[].attributes.subject
Good work, Nicola, sometimes good ideas are generated from people who might consider that they are inexperienced whereas in fact, they can provide insight through 'fresh eyes'. 

# data[].attributes.body
Sue G

# data[].attributes.headline
Excellent work, Dallas, in identifying how collaboration can be used to inform and support effective decision-making 

# data[].attributes.subject
Excellent work, Dallas, in identifying how collaboration can be used to inform and support effective decision-making 

# data[].attributes.body
Sue G

# data[].attributes.headline
Good work, Allington. You have highlighted some of the important aspects of leadership, namely, communication, networking and innovation.

# data[].attributes.subject
Good work, Allington. You have highlighted some of the important aspects of leadership, namely, communication, networking and innovation.

# data[].attributes.body
Sue G

# data[].attributes.body
In the position as owner of the health care facility I am the leader and figurehead of the whole facility, I represent the organisation and in part am responsible for leading, managing and organising staff, patients and profit (Lussier & Achua, 2013). As an owner my goal is to make a profit whilst also providing and caring for staff and the community.
Within this situation I would firstly acknowledge that if no other solution to create profit or cut costs can be found I would close the satellite facility. My rationale for this action would be that I cannot run a facility that does not create a profit or at least cover its operating costs. It is foreseeable that if the healthcare facility continues to be unprofitable the whole facility would be closed, which would be detrimental to all staff and the community. Thus if no other solution is found it is in the best interests for the majority of staff to close the satellite rehabilitation facility. However, this action would be as a last resort only.
Next, having recognised that spending to update the whole facility would still result in overheads being uncompetitive with the new neighbouring facility and unlikely to increase profit.  I would consider what our facility offers that competing facility does not, rehabilitation. It has been identified that the community is dependent on the rehabilitation facility. To the extent that the community fundraises to support the rehabilitation unit. Furthermore as identified when considering the impact of unit closure on ageing staff, there are no other convenient rehabilitation facilities located nearby.
Therefore it can be acknowledge that there is a demand for rehabilitative services. Thus I would look to invest in the rehabilitation facility, possibly if updating and extending it, potentially with the support of community fundraising. I would advertise in other nearby locations which also lack rehabilitative services and seek to turn the smaller satellite facility into a larger profitable facility. Hopefully the provision of rehabilitative services would encourage patients to choose our healthcare facility for other procedures, and over time the facility could be updated. However, if the rest of the facility continued to run at a loss and the rehabilitation unit became profitable I would look to repurpose parts of the larger facility into rehabilitation services. Staff could then be retrained in rehabilitation or alternatively if this does not appeal to them they could seek employment at the new completion healthcare unit.
This strategy is how I would manage this crisis situation as an owner and leader. Another solution could be to sell the facility to a large healthcare corporation who can afford to update the facility. However, the risk of this action is that the impact of new ownership on the staff and community is unknown. I look forward to hearing from others about how they would manage and choose to lead in this situation.

# data[].attributes.body
I am fairly inexperienced RN so I don't have much experience in this area. But there are some interesting points posted by others here. I agree that other options need to be explored. Denying critical services to the community isn't in the best interest for the service or the community. Perhaps instead of trying to compete same-for-same with the newer provider, if it was at all possible, the hospital could cooperate with the new facility and liaise with the community in order to fill existing gaps in service. Letting the newer facility do what it's doing well and for the older facility to change focus or specialise in other areas of care and maintain the rehabilitation centre as one of its lead specialities. It is doubtful that closing the rehabilitation centre would sufficiently relieve the financial burden on the hospital and it would also looked kindly upon with the community, increasing negative sentiment towards the hospital.

Nicola

# data[].attributes.body
With no management experience this was a tough one to answer. I rFound myself thinking t
That whatever decision was made that someone would be affected.

Like many of you my first response was why close a service if it is the only one offered in the area setting you apart from the "competition". Further thinking about this however I realised that the rehab service will cease to function without the effective running of the Heath care facility itself.

I started thinking about the overall service and how to keep that running, In the meantime closing the rehab service along with exploring other cost lowering ideas. Getting the main facility effectively running may lead to being able to re advertise, improve outcomes and possibly reopen the rehab in the future

In aiming to keep the rehab open Stakeholders could play a major role in supporting the facility it was identified the community has great involvement is there a possibility of exploring outsourcing to community organisation or s business plan to work in collaboration to reduce costs to the main facility.

Being transparent with the staff about the changes and also the dilemmas that are being faced would go a long way in understanding and may lead to improving work engagement or the willingness to engage however if the business is facing economic strains, I am not convinced improving work engagement and technology alone will be the answer.

Without more information I found it hard to make one decision.

Thanks for reading

Jessica

# data[].attributes.headline
WEll there is the sensible answer to the financial situation and that is to close the Rehabilitation unit. Then their is the moral answer which would be to consider the people affected and what would I like the decision to be if I was going to be in need of Rehabilitation. Therefore the answer would be to keep open. I have the feeling that the volunteers would pull together and human spirit would pervail to do more fund raising to keep it open.

# data[].attributes.subject
WEll there is the sensible answer to the financial situation and that is to close the Rehabilitation unit. Then their is the moral answer which would be to consider the people affected and what would I like the decision to be if I was going to be in need of Rehabilitation. Therefore the answer would be to keep open. I have the feeling that the volunteers would pull together and human spirit would pervail to do more fund raising to keep it open.

# data[].attributes.body
People really do pull together with this type of moral dilemma
Thanks
Patricia

# data[].attributes.body
This case study is a perfect example of the dilemma faced my health care managers who need to balance organizational need with need for ethical balance. My initial reaction when reading the case was to keep the satellite rehabilitation facility open as it an important resource for the municipal and is employed by locals which keeps jobs in the community. Before I can even begin to wrestle with a decision like this one I would need a lot more information about the nature of the overheads on the main facility, and what other methods have been looked at to decrease its running costs. However, I can see merit for closing the facility if keeping it open would lead to the delivery of sub-standard care.  Self-awareness is an important part of the decision making process as it allows for the evaluation of key values and can lead to managerial effectiveness. Irrespective of the decision made it’s the way in which the decision is made that is important. Due to the number of people effected by the decision the process should be transparent and involve all the key stakeholders. I personally believe based on the information presented in the case study that I would advocate for the satellite facility to stay open as it is important part of the community.

# data[].attributes.headline
I think the decisional dilemma I would grapple with in this case
study is how to keep both the health care facility and rehab unit open and
economically viable, as I believe that that would be the best outcome for the
community. But how to do this within budget constraints while maintaining
quality of care and the best outcomes for the patients, staff and the community
in general? As a manager, I would be limited by my budget. Improving the private
health care facility by updating some of the technology and processes and improving
staff engagement would probably be my priority. Enhancing the quality of service
and staff satisfaction should lead to a positive feedback loop and improve the health
service at all levels. However, the rehabilitation unit is obviously an
integral part of the community as it allows patients to be treated locally and
employs local people, so it would benefit the community to keep the facility
open. Many regional communities have been threatened with bank, school and kindergarten
closures, but the communities have been able to keep these services ongoing through
periodic fundraising and community involvement. So as the manager of the health
facility, I would try to involve the community in assisting in keeping the
rehab unit open and viable. I would probably begin by investigating what
resources would be required, then consult with my staff, the executive and the
community, alert them to my dilemma, and suggest establishing a task force of key
stakeholders (including the rival health facility) to identify the level of
community support for the unit.  As a group
with a common interest, we may then determine if there was enough community
support and decide on a course of action to assist in providing ongoing funding.
The rival health facility could also approached with the idea of sharing the costs
of the rehab unit between the two health facilities in order to retain its
benefit to the community. I believe it is important for regional communities to
have access to these facilities, but I also understand that due to limited
funding, many things are not possible without collaboration. 

# data[].attributes.subject
I think the decisional dilemma I would grapple with in this case
study is how to keep both the health care facility and rehab unit open and
economically viable, as I believe that that would be the best outcome for the
community. But how to do this within budget constraints while maintaining
quality of care and the best outcomes for the patients, staff and the community
in general? As a manager, I would be limited by my budget. Improving the private
health care facility by updating some of the technology and processes and improving
staff engagement would probably be my priority. Enhancing the quality of service
and staff satisfaction should lead to a positive feedback loop and improve the health
service at all levels. However, the rehabilitation unit is obviously an
integral part of the community as it allows patients to be treated locally and
employs local people, so it would benefit the community to keep the facility
open. Many regional communities have been threatened with bank, school and kindergarten
closures, but the communities have been able to keep these services ongoing through
periodic fundraising and community involvement. So as the manager of the health
facility, I would try to involve the community in assisting in keeping the
rehab unit open and viable. I would probably begin by investigating what
resources would be required, then consult with my staff, the executive and the
community, alert them to my dilemma, and suggest establishing a task force of key
stakeholders (including the rival health facility) to identify the level of
community support for the unit.  As a group
with a common interest, we may then determine if there was enough community
support and decide on a course of action to assist in providing ongoing funding.
The rival health facility could also approached with the idea of sharing the costs
of the rehab unit between the two health facilities in order to retain its
benefit to the community. I believe it is important for regional communities to
have access to these facilities, but I also understand that due to limited
funding, many things are not possible without collaboration. 

# data[].attributes.body
Dallas