Movie Analysis: Damaged Care Organizations

Damaged Care
Health care organizations are complex entities whose theory and structure have evolved and transitioned over time. In the late 1980s and early 1990s health care experienced a paradigm shift as managed care organizations guided health care practices by managing the care between patients and physicians in order to drive down health care costs. This transition has created controversy and discontent as physicians, patients and payers balance what is required to ensure quality care. The movie Damaged Care, directed and produced by Harry Winer in 2002, introduced the organizational structure of the managed care organizations, the hierarchy of care within the organization, the power struggle within those organizations and the impact

88).The film inspects Dr. Peeno’s realization of this concept in her first position was at Humana, an HMO, as a medical reviewer. HMOs such as Humana are based off of bureaucratic principles that take the personal perspective out of business (p. 36). As seen in Damaged Care, the structure was based off of a hierarchy that employed and enforced impersonal rules and principles of the organization (p. 36). When Dr. Peeno began her career at Humana, the organizational structure was explained to her very clearly; the nurses reported to the utilization review manager who reported to the medical reviewers who reported to Dr. Scarwood, the head of Medical Services. Avery Principle, one of the medical reviewers, explained to Dr. Peeno that the main objective at Humana was to get the physicians to refrain from ordering unnecessary procedures, which wasted funds. This explanation supported the interviewer, Mr. Gulson’s question to Dr. Peeno, when he asked her if she was good at saying no. Due to Dr. Peeno’s earlier experiences in medical school with her instructor ordering an unnecessary gall bladder surgery, she stated she could do definitely say no, for it was the right thing to do. Dr. Peeno did not realize that for the organization, saying no was a means of survival and safety for Humana, for it allowed Humana to save money and out of the

Peeno’s personal motivation, but also through the broader review of organizational behavior and the interface between the organization and the individual human behavior as it applies to generalized motivation. Some organizations employ different theories in order to motivate its employees. Humana, in an effort to incentivize its medical reviewers, utilized the House’s Path Goal Theory, which is based off of an expectancy motivation theory (p. 180). Ultimately, people will be motivated to get the organization’s desired outcomes if a reward is involved. In order to look out for the bottom line and stay out of the red, Dr. Scarwood utilized legitimate power, which derived primarily from authority (p. 139). In order to improve team effectiveness, Dr. Scarwood used his power to demand that all of the key players would meet weekly to review the individual denial rates and discuss the results as a team (p. 119). This data is referred to as objective outcomes by Johnson. Evaluating the data openly with the group would improve the numbers and improve employee satisfaction through review of the achievements made throughout the week (p. 90). To improve that data, Dr. Scarwood added an extra paid incentive to do the job