Case—Miller Pain Treatment Center

On a cool Saturday morning Dr. Keith Weems walked briskly down the hallway toward the main entrance to Eastern Hospital (JHH). He was on his way to visit in-patients in several wards as part of his duties as the pain specialist on call for that weekend. However, his mind kept drifting to issues he was facing as the new manager of the Miller Pain Treatment Center in the neighboring Eastern Outpatient Center (E-HOC). Dr. Weems had been working as part of the Eastern system for several years. However, he recently merged his successful private practice into the Miller Pain Treatment Center and was appointed as its director. In so doing he moved from a setting where he was the clear boss to one in which he was dealing with a collection of more established doctors already set in their ways. He also had to figure out how to improve the care delivery process in this environment, which considered itself to be part of the premier teaching hospital in the world. After reviewing the operations and meeting the staff he was coming to grips with the fact that this new setting was much more complex than his old practice in a myriad of ways. Additionally, between treating outpatients and in-patients, managing the clinic, teaching medical students, and conducting research, it was clear that the complexity of the job mirrored the complexity of the operating environment. However, he was confident that he could find ways to get this larger clinic to surpass the success of his old, simpler practice.