The Honeysuckle Clinic is a community, rural health clinic, which is open 6 days a week and currently manages nearly 4000 patient visits annually.

The Honeysuckle Clinic is a community, rural health clinic, which is open 6 days a week and currently manages nearly 4000 patient visits annually. The staff includes one full-time administrator, one full-time nurse practitioner, two (Part-time nurse practitioners, one full-time intake specialist, one full-time receptionist, and one part-time medical coder/biller. Mental health services, physical therapy, and some complementary and alternative medicine therapies are done by contract providers. Lab services are available 3 days a week. The dental program costs are covered by a grant that covers the cost of a dentist, hygienist, and dental assistant, all of whom work pare-time. The clinic is a Medicare/Medicaid provider and accepts most insurance plans. Patients are encouraged to pay in cash rather than with debit and credit cards due to the fees incurred by both the clinic and the patient with card use. This is just one more attempt by clinic administra­tors to keep patient costs as low as possible.

Patients receive assistance in accessing pharmaceutical benevolent pro­grams. The practitioners work diligently to prescribe generic medications that can be purchased at low cost through a number of large retailers. The clinic does keep on hand some emergency and sample brand name products.

Nola Salem is the clinic's director. She has 0een on the job approxi­mately 3 years, arriving after a period of financial difficulty and declining grant monies nearly closed the clinic. Ms. Salem reports to an independent Board of Directors c0nsisting of 12 area citizens and community leaders. Of the 12 members, 4 are patients of the clinic as required by state law for facilities receiving state grant monies. The Board meets bimonthly at the clinic.

Since Ms. Salem arrived, Honeysuckle has been awarded numerous grants and is currently financially stable. The annual budget for this thriving clinic runs approximately a half million dollars.

Ms. Salem was asked to describe her leadership style. Some of her self-. descriptions include the following:

"I am not a micro manager. Each clinician or staff member was hired to do a job. If someone is not doing his or her job, then that person needs to go."

"I like to stay organized and insist that employees make an appointment if they need to discuss something in private. It helps us all to stay on track."

"I want to hear their ideas. None of us is comprehensively trained in all fields. Each employee contributes to the team that makes up Honeysuckle."

"We brainstorm a lot."

"There are no big people here, only small puzzle pieces that make up the whole. We each need the other and his or her ideas and skills to complete the picture."

"Everybody's responsible for a piece of that puzzle."

"I make it a point to walk through the clinic every day so if any employee needs to talk with me, I'm available."

"After I make a decision, my employees are expected to 'get 0n the band wagon' and get it implemented."

Ms. Salem does have a regularly scheduled staff meeting with the full­time employees, with part-time employees attending when possible. M0st staff meetings are held with 5 minutes notice while all employees are on the run. She notes the luxury of having a small practice. "We can move fast,'' she remarks. "If we need a new form created or need to make a policy decision, we do not need committees. We do not work in a slow, cumbersome process like in a larger healthcare system. We can decide something at 10 A.M. and put it in place at noon."

The clinic's Medical Director, Dr. Seymor, has the final approval on clinical changes. Nurse practitioners feel that they are routinely ignored when they present requests for more information. They feel like they are given no choice about patient flow and documentation, when they are the ones in actual practice with patients. Per policy, Dr. Seymor reviews 100% of the clinical records, but is not present onsite. While the nurse practitioners were willing to talk candidly about the clinic, other employees were reluctant to discuss their leader. All of them declined, citing the constant fear that they might lose their jobs at a moment's notice.

After reading and reflecting on this case study answer the following questions:

1. Nola Salem, through her business background, has brought many improvements to the Honeysuckle Clinic in the past 3 years. However, there are no strategic plans yet in place. The Board of Directors is pleased at the influx of grant funding, but the staff members worry when the new budgets are announced. Staff reveal that they cannot anticipate if they will have employment on a long-term basis—and morale plunges. Is Ms. Salem a transformational leader? Justify your position. If not, how might a true transformational leader handle some of these issues?

2. Ms. Salem has just tendered her resignation to take another position. The Board of Directors hired a consultant who has recommended that the clinic seek a transformational leader to lead Honeysuckle into the next decade. Relative to what you know about the clinic's structure, financial status, and patient base, what traits should this new leader embody? What questions might you ask the candidate you are interviewing to determine his or her leadership philosophy?

3. You are a community leader in an area similar to the region served by the Honeysuckle Clinic. One of the area's largest employers has just closed its doors, leaving many of your community's "breadwinners" unemployed and uninsured. Your locality seeks a healthcare provider to offer locally-based, reduced-fee medical care to its population and turns to you to coordinate the recruitment of this practice or organization. The medium-sized state university 50 miles away has a large nursing school, and nurse practitioners from its faculty have agreed to staff an outpatient clinic on a volunteer basis until a new practice is fully established. As you begin planning for the new low-cost services you plan to launch, you and your team make a site visit to Honeysuckle to observe and learn from their experiences. You have questions about recruitment and retention of qualified medical staff, about the aging of the healthcare workforce, and about how changing technology and healthcare reform demands for accountability and quality may impact your proposed clinic. Please prepare a list of topics/concerns to be discussed.

How would you apply what you have learned from this case study in your current and future practice as a leader and/or manager?