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

it has on the clinical decision making and ultimately the patient. This paper will use the managed health care model upon which this movie is based to analyze the concepts of organizational theory behavior and development presented by Johnson (2009).
The organization described in this movie is a system of healthcare that controls costs by through managed programs in which the organization is dependent on its relationships with insurance companies for survival. This movie uses the concept of resource dependency theory to tell the story of the potential effects of a system based on internal and external coalitions that regulate the possession of critical resources. Pg?
The first evidence we see of this system’s effect on its internal stakeholder’s behavior is in the form of Dr. Linda Peeno the lead character in Damaged Care. Her story begins with the discussion of the inner voice that defines and changes an individual. This inner voice can be described as motivation (p. 87). Johnson explains that it is the key to understanding what drives not only individuals but also those that lead bigger organizations such as health care industries and even HMOs. Everyone has different motivators and different agendas. Resource dependency theory holds that organizations have a strong motivation to behave in a manner which meets their funders’ accountable demands. In the film, Winer explores how the organizational behavior required to meet the demands of these stakeholders affects its participants. By examining Maslow’s Hierarchy of Needs, Dr. Peeno’s personal motivators are able to be categorized and better understood (p. 88). Maslow’s needs are made up of extrinsic factors which include physiological needs, safety needs and social needs. Once these extrinsic factors are met, the individual has needs that can be coined as intrinsic factors which include esteem and self-actualization.
The bottom rung of Maslow’s hierarchy is physiological needs (p. 88). The film clearly demonstrates an example of how Dr Peeno’s physiological needs impacted her choice to work for this agency. Dr. Peeno took a great deal of time off once she graduated from medical school to take care of family. This bottom rung of the hierarchy explains her desire to go back to work. Her family could not live off of her husband’s paycheck alone. They had bills to pay, so Dr. Peeno was eager to return to the workforce.
The second rung of Maslow’s theory was safety which, in the business world, could be termed job security (p.

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

red.
Maslow’s third rung was the social need desired by individuals. Dr. Peeno’s motivation and desire for “social acceptance” is evidenced by her participation in the “team” at Humana. This need at work is the camaraderie that forms when groups and teams form (p. 110). According to Johnson, groups are two or more people that interact and share a common purpose. A team is a type of group that has a common purpose, each member has a role and they are all interdependent upon each other. In following Dr. Peeno’s experience in the film with Humana, we see, there are two different teams. The first is the utilization review nurses and the second is the medical review physicians. The story focuses on those physicians and their common goal to stop the physicians from billing up the insurance. Dr. Peeno’s team included Dr. Stan Burbish and Dr. Principle.
Within each team, the team member role is clearly defined (p. 112). In the case of Damaged Care, Dr. Peeno was told her job was to review cases denied by the utilization review nurses and determine if they should truly be denied. Dr. Peeno’s curiosity drove her to investigate the cases and make sure a denial was truly the right plan of care (p. 93). This intrinsic motivator represented a possibility for differences in knowledge, goals, and outcomes for the organization and which would potentially compromise the organization’s goal, thus require Dr. Stan Burbish to reinforce Dr. Peeno’s role when he told her she was not the PCP and to stop getting so involved in the care. Dr. Peeno quickly learned that the desired outcome was denials and as long as she denied claims, she was accepted by her peers.
Not only can we discuss the organization in the film via Dr.

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

well.