Watergate Nursing Home: A Case Study

Watergate Nursing Home is a private, non-profit 178-bed capacity nursing facility located in Washington, D. C. It was purchased five years ago by a non-profit corporation based in New York City. It is the second largest facility owned by the corporation and the only one with more than 50 percent public pay residents. The managerial staff of Watergate is composed of Mr. Merrian, the administrator; Dr. Phelps, the medical director; Mrs Kay, the nursing supervisor; Mrs. Hill, the dietary supervisor; Mr. Wing the head of housekeeping, and Mr.

Black, the head of Maintenance. Watergate is being supervised by the corporate supervisor, Mrs.

North, who visits the facility every month. Mrs. North has a reputation of being modern in her managerial methods and although she is nice,she is not very much welcome at Watergate since the staff are traditional. They consider the corporate supervisor as an outsider who gets in their way of running the facility. On Mrs. North’s first supervisory visit to Watergate, she requested for reports from the different departments and asked for a two hour daily meetings with the staff.

In her two-week stay in the facility, a number of concerns have been noticed that needs to be addressed.

Mrs North found out that the administrator, Mr. Merrian, had been with the company for five years already. He oversees all details of the operation. He is well-liked by the staff since he is not demanding and is quite lax in his managerial technique. He does not put any pressure on his staff and allows them free reign on their respective departments.

Credentials-wise, he is qualified. He has a degree in business aministration and has worked as an assistant administrator prior to working at Watergate. However, he is soft-hearted and avoids confrontations with any member of the staff for fear that he might hurt them.

Thus, department concerns are left to their respective heads to be solved and answered. The second concern that was noted was in the dietary department. Mrs. Hill’s budget showed a sudden rise in raw food cost and for the past two months she had been over budget. According to her she was having food shortages particularly on weekends despite ordering proper amounts of food. It was also noted that there is an increase in absenteeism and lateness in this department. Likewise, employees were frequently meeting in small groups when the supervisor was not around. The administrator, however, was not doing anything about it and was reliant on Mrs.

Hill to solve this particular problem. The maintenance department, on the other hand did not meet the standards of the health department. Their problems included lack of preventive maintenance schedule, failure of the staff to attend safety committee meetings, and out-of-date maintenance manual. The corporation has already submitted a plan for preventive maintenance schedule subject for implementation by Mr. Black. However, he had not complied with the schedule and still missed committee meetings. Mr. Black did not have the patience and the leadership skills to have the necessary plans implemented.

There were also electrical repairs that needed to be fixed. There was also a fire incident that was allegedly due to a lighted match that was thrown in the garbage can. On top of the repairs, there was also a problem on the strict implementation of the smoking policy. In the nursing department, the problem lies on the doctors. The morale of the staff was high, however, they were getting discouraged because doctors were not actively interested in their patients. This was because their clinic schedules in Watergate were not regular, hence, no genuine patient-doctor rapport was established.

Dr. Phelps was not able to address this problem although he was already aware about it. In the housekeeping department, the employee turnover was high although absenteeism is low. It was found that Mr. Wing, the department head is very strict with regard to absenteeism. Employees were not allowed to be absent. There was a great deal of tension and dissatisfaction among the employees due to the strictness of the department head. Mr. Merrian was aware of this but the employees could not tell them of their grievances because he would not meet with them without Mr. Wing.

Among the residents, there were incidents of theft. The residents seemed to be happy though. It was noted that there were a number of residents recommended for a lower level of care. This would mean that these residents need to be released from the facility since Watergate was not licensed for independent patient care. Independent patients would need individual living units with primary health care. Lastly, Watergate needed a five-year strategic plan inclusive of expansion of existing facilities. This plan would be submitted to the corporation headquarters. Mr.

Merrian has not started with these plans yet. Facts of the Case This is a case of a 178-bed capacity nursing facility catering to private and public pay residents, located in the urban area of Washington, D. C.. The facility had been under a private corporation for five years already with no operational problems. However, on a closer look, there were internal problems that were noted. Mr. Merrian, the administrator who personally oversees the overall operation of the facility was under the supervision of Mrs. North, the newly designated corporate supervisor. Contrary to Mr.

Merrian, Mrs. North is modernistic in her managerial methods and prefers an aggressive approach to the problems of the facility at hand. Mr. Merrian, on the other hand, lacked the iron leadership to implement changes in the facility. His traditional managerial technique, is completely reliant on the decisions of the department heads of Watergate. Each of the department supervisors of the facility felt that their respective departments were problem-free. They were all traditional that they do not consider the wholistic effect of the minor problems in their respective department. Mrs.

North was assigned to bring Watergate to corporate standards and to address its inadequacies in patient care, dining and eating assistance, medication distribution and preventive maintenance. She was hopeful that the strategic plan that she and Mr. Merrian would devise could answer these concerns. Thereby, uplifting the quality of care and facility that Watergate can give to its residents. Assumptions Based on the case presented, the following assumptions can be raised. Firstly, it can be assumed that Mr. Merrian would be able to devise a strategic plan that would address the present problem of each of the department.

Second, it should be assumed that Mrs. North would be able to bridge between the employees and their respective supervisors as well as the administrator. It should be assumed that Mrs. North would be able to enlighten Mr. Merrian and his department heads on the presence of problems in Watergate. It is crucial that these people realize that there are existent concerns that needs to be addressed , that much improvement is needed in terms of managerial techniques. Problems and Issues that need to be addressed 1. Mrs. Hill’s overbudgeting. 2.

The tension and dissatisfaction among the employees under Mr. Wing’s supervision. 3. The substandard maintenance of the facility. 4. The poor rapport between doctors and nurses and between doctor’s and patients. 5. Mr. Merrian’s leadership style. Alternatives and Solutions First, let us tackle the problems in the dietary department. The problem in overbudgeting was brought about by the open door policy to the residents and their family. Mr. Merrian has maintained this policy which allowed the residents to bring in their family to the facility.

During weekends, more family members can visit the residents, hence, the shortage on food. The family members may be allowed to visit on weekends but they should not be covered by the food expenses or the food supply in the facility. Visiting family members should bring their own food and supplies. The budget and food allotment should be strictly limited to the residents and staff. Mrs. Hill may also opt to revise her menus particularly on weekends when food shortage usually occurs. Simpler menus may require smaller budgets. Likewise, Mrs.

Hill could open a canteen or a store that would sell food to the visitors. A canteen or store may also be opened in the facility wherein visiting family members can buy food for their consumption while they are in the premises. Residents can also buy if they like. This will be able to generate additional income to the department and the facility. If Mrs. Hill could not afford to have her own canteen, the canteen may also be opened for consignments and concessionaires among family members, with monthly rentals to Watergate as well as a percentage share from the income.

Since many visitors come to Watergate, this may be a good business venture. As noted, there was an increase in the number of tardiness and absenteeism among the dietary staff. The small group meetings that occur whenever the supervisor is not around may precipitate a rising of a union group. These incidents indicate that the staff have some source of dissatisfaction which needs to be investigated. These small group meetings, if not fixed early, may lead to a bigger strike among the employees. It is possible that Mrs. Hill was spending some of the budget and the staff was aware of it.

Hence, it is a long term plan to conduct a monthly or quarterly audit of the budget and expenses of Mrs. Hill. There should be a check and balance since there is money involved. The problem in the housekeeping department is very crucial. It is important for the staff to feel important and valued. The high turnover of employees should be addressed. Loyalty among new employees would be difficult to obtain. It is the responsibility of Mr. Merrian to balance the strictness of Mr. Wing. Likewise, it is important to meet the staff without Mr. Wing around so that the former would be able to air out their grievances.

This way, Mr. Merrian would be able to bridge the gap and iron out the feeling of dissatisfaction among the staff. Meanwhile, Mrs. North can talk to the housekeeping staff. She might be able to convince them to air out their problems and take appropriate actions or recommendations. The long term plan could include more incentives to loyal employees and to the good performers. Incentives may not necessarily be monetary, rather it could be in the form of citations and awards With regard to the problem in the maintenance department, it is important to remind Mr. Black regarding the scope of his responsibilities.

The new procedures in the “plan of correction” should be implemented as soon as possible. The fire incident , though minor, was an indicator that the policy on smoking was not strictly implemented. The incident should be a warning for Mr. Black to tighten his rules on the no smoking policy of the institution. Mr. Black had also mentioned the lack of manpower to get the repairs done. The residents may be encouraged to take part in the repairs. The family members may be asked to help too. Major repairs that needs additional manpower and funding may be reported to the headquarters.

Volunterism from the residents and the family members may be solicited. Considering the good camaraderie and the happy environment among residents and staff, help will not be difficult to obtain. Mr Black seems to be negligent in most of his duties. If he does not improve and change his ways, replacing him with a new department head would be a radical but good solution. The problem between the nurses and the doctors may be addressed by giving more incentives to the doctors who have patients in the nursing home. Dr. Phelps should encourage the doctors to conduct rounds with the patient.

The corporation should hire more resident doctors. If this is not possible, Dr. Phelps should make more effort in establishing doctor and patient rapport. He can schedule meetings between doctors and nurses weekly or even twice a week just for patient and treatment updates. If possible, another meeting with the staff and the patients will be conducted even once a month so that patients can also be updated with their treatment . They can be given a chance to talk with their respective doctors as well meet other doctors which they can consider as future physicians.

Such conferences will likewise be beneficial to the doctors because they will be given the chance to get more patients. Lastly, with regard to the poor leadership style of Mr. Merrian, Mrs. North should present the results of her findings to Mr. Merrian. He should be made to realize that even though his department heads seemed to be self-reliant, his close supervision over them is still necessary. Being the overseer of the facility, it is a must for him to ensure that his department heads are doing their job well. Regular conferences may be conducted to monitor activities and concerns in all departments.

Specifically, he should talk with the employees in the housekeeping department to listen to their grievances or problems. There are ways to solve problems without being confrontational, so his fear of hurting his staff may be avoided. Mr. Merrian should call Mr. Wing’s attention regarding his method of running the housekeeping department. High employee turnover is not good for the company. Loyalty is difficult to obtain from new employees. Mr. Merrian should also check on Mrs. Hill’s market list to ensure that the budget really goes to the food and not to some extra items which are not for the facility.

An addendum to the open door policy should also be implemented which include prohibition of visiting family members from eating in the facility. Mr. Merrian should structure his strategic plans along the current problems aforementioned. These problems have arisen due to poor leadership abilities and style. It is possible to be effective without jeopardizing her good reputation among his staff. Implementation Plan The plan for the improvement of the system in Watergate should involve mainly, Mrs. North. Being the corporate supervisor, she is superior to Mr. Merrian.

Therefore, she is the right person to impose the changes in Mr. Merrian’s leadership style. She is also the person who is able to detect that changes need to be made. Moreover, Mrs. North can make the necessary recommendations to the head office regarding the performance of the administrator. The next person that should be involved in the plan implementation is Mr. Merrian along with his managerial staff. For the plans to be successful, the full cooperation of the department heads is necessary. These people are traditional in their ways and eliciting their cooperation would definitely be difficult.

Hopefully, in time they would be able to see the need for change and improvement and would cooperate. The residents should also be encouraged to join in the implementation plan. They should be made to realize that improvements are being instituted for their welfare so that they will be encouraged to follow new rules and regulations. The family members should also be aware that new plans for the improvement of Watergate are being instituted. A conference may be called and plans may be presented to them in order to generate support and suggestions.

Lastly, the headquarters should be made aware of the plans. Additional budget and allocation will be needed to make these plans feasible. Repairs of dining areas, electrical repairs, and additional independent living quarters entail additional cost in terms of labor and materials. In general, the plan implementation requires the concerted efforts of all the people involved with Watergate. They should be encouraged to be supportive since the improvements that will be done would be beneficial to all persons involved. Conclusion

The ultimate objective of bringing Watergate up to corporate standards would be a slow but possible process. The main obstacle in this goal is the existent traditional attitude of the managerial staff which could prove resistant to any form of change. Mrs. North is faced with a great challenge of winning the cooperation of the managers and staff who are set in their ways. The suggestions and plans may be taken negatively by the managers. She has set a six month time-frame for these plans and its going to be a tough job. Nevertheless, as long as she is able to maintain good rapport with the managers, this is feasible.

Furthermore, the fact that despite the aforementioned problems, Watergate has maintained good relationship with the residents and their families, is a indicates that the managers are basically good people who are concerned with their residents. The key to the success of these plans is to make the managerial staff realize that the plans are for the welfare of Watergate. Watergate has been solvent for five years already. Given the necessary support and guidance from the head office, and from Mrs. North, raising the standards of Watergate is not an impossibility.


Infeld, Donna. Moon, Dorothy. Watergate Nursing Home.