HA515 Unit 7 Delegation and Accountability Case Example

Fourteen Monkeys in Six Weeks: A Delegation and Accountability Case on a Composite Ambulatory Surgery Center's Pre-Operative Phone Calls, Handed to the Charge Nurse in a Hallway and Returned, Issue by Issue, to the Administrator's Desk

[Student Name]

Purdue University Global

HA515: Leadership and Management in Health Care

Unit 7 Delegation and Accountability Case

[Instructor Name]

[Date]

The surgery center, the staff and every count are composite and bracketed; the case is a course exercise in delegation, not a review of real employees.

The Delegation as Made

The administrator, a former finance manager, told the charge nurse in a hallway that she would "own the pre-op calls from now on." The calls, made two business days before surgery, confirm arrival times, fasting instructions, medications to hold and rides home. Half are made by nurses and half by two schedulers who report to the business office. Nothing was written: no scope, no authority over the schedulers and no measure.

The Return Traffic

Over six weeks, [14] issues came back to the administrator:

1. Schedulers asking whether they now reported to the charge nurse ([three] times).

2. Patients who could not be reached, with no rule for what to do next ([four]).

3. A surgeon asking why his patients received different fasting instructions ([two]).

4. A family asking to change the arrival time ([two]).

5. The charge nurse asking whether she could reassign a scheduler's calls ([three]).

Monkeys

Oncken and Wass described each unresolved next step as a monkey that leaps from a subordinate's back to the manager's whenever the manager says "let me think about it" or "send me a note" (Oncken & Wass, 1974). Every one of the [14] issues was a monkey the delegation itself had left without an owner. The charge nurse was given responsibility for the calls without the authority to direct half the people making them, so every hard question had nowhere to go but up.

Why Each Monkey Returned

Classifying the [14] issues by why they came back: Missing authority: [six], the scheduler questions and the reassignment requests. Unclear scope: [five], the unreachable patients and arrival time changes, which nobody had defined. No decision rule or measure: [three], the fasting instruction inconsistency, which needed a standard the charge nurse could enforce.

What a Non-Clinical Administrator Can Delegate

The administrator can delegate ownership of the call program, its process, its staffing and its measures. She cannot direct the clinical content of the calls, such as which medications to hold; that belongs to the anesthesiologists and nurses. The joint national guidance from nursing's regulators and professional association limits clinical delegation to what each worker's license and training allow, and keeps the delegating nurse answerable for the result (National Council of State Boards of Nursing & American Nurses Association, 2016). The schedulers can confirm logistics; clinical questions must go to a nurse.

Redoing the Delegation

A one-page written delegation now states:

1. Scope: all pre-operative calls for scheduled cases, including unreachable patients and arrival changes.

2. Authority: the charge nurse assigns all calls, including the schedulers', and can change arrival times within a set window; the schedulers' business office manager agreed.

3. Clinical standard: fasting and medication instructions follow the anesthesia group's written protocol; deviations go to the anesthesiologist on duty.

4. Decision rules: two attempts to reach a patient, then a text and a message; if unreachable by noon the day before, the case is flagged to the surgeon's office.

5. Measures: percentage of patients reached; same-day cancellations for preventable reasons.

6. Check-ins: fifteen minutes every two weeks, where the charge nurse brings decisions made, not problems to be solved.

What the Charge Nurse Said

Asked why the issues came back, the charge nurse said: "I didn't know if I was allowed to decide. The schedulers aren't mine, and the patients who don't answer aren't in anybody's policy." She had accepted the work but not the authority, because no one had offered it. Her account matches the classification: most returned issues were questions about permission, not competence.

The Administrator's Part

The administrator also kept monkeys alive. When the first scheduler question arrived, she said she would look into it, which taught everyone that hard questions went to her. A better reply would have been to ask the charge nurse what she recommended and to give her the authority to decide.

Why Managers Hold On

Research suggests managers delegate more when they trust subordinates' competence and when the task is less critical to their own goals (Yukl & Fu, 1999). The administrator trusted the charge nurse fully; her failure was not reluctance but vagueness, which produced the same result.

Results After Four Weeks

Issues returning to the administrator fell to [two], both genuine policy questions. Patients reached rose from [81] to [93] percent.

Limits

Four weeks is a short follow-up; the schedulers' agreement depends on their manager's continued support.

Conclusion

The pre-operative calls returned to the administrator because the delegation lacked authority, scope and rules. Writing those down, and leaving clinical content with clinicians, kept the monkeys with the charge nurse, where they could be fed.

References

National Council of State Boards of Nursing & American Nurses Association. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3

Oncken, W., Jr., & Wass, D. L. (1974). Management time: Who's got the monkey? Harvard Business Review, 52(6), 75-80.

Yukl, G., & Fu, P. P. (1999). Determinants of delegation and consultation by managers. Journal of Organizational Behavior, 20(2), 219-232. https://doi.org/10.1002/(SICI)1099-1379(199903)20:2<219::AID-JOB922>3.0.CO;2-8