Healthcare case study

This is the case I chose and the instrutions are also attached. 

An Affair at Work
Sharon B. Buchbinder

Dr. Snuggles, a hospital intensivist,* works 12 hours on and 12 hours off in the Medical Intensive Care Unit (MICU) at Riverfront Medical Center. What Dr. Snuggles lacks in looks, he makes up for with self-confidence and a cheeky sense of humor. Despite being married for 20 years to the same woman, he propositions almost every female he meets. No one takes him seriously, and the women joke back and forth with him. That is, until a rumor begins to circulate Dr. Snuggles really is having an affair.

As the nurse manager of the MICU, you are used to the rumor mill. You have a million things on your plate, and this item goes on your very long TO DO list. You make a note to yourself that when you have time, you will speak with Dr. Snuggles in private. You will tell him that while no one has formally complained, his behavior is bordering on sexual harassment and people are saying things.

You go home after a long day and fall asleep as soon as your head hits the pillow.

At 3 am, the phone rings. The callers voice is slurry, as if hes drunk.

Dr. Snuggles is having an affair with Bob.

You are half asleep and say, Who is this?

Dr. Snuggles is GAY.

The caller hangs up. You check the caller ID. The number is blocked.

Now you are wide awake. Bob is an RN who reports to you in the MICU. An excellent nurse, Bob works alongside Dr. Snuggles every day. Ridiculous. Dr. Snuggles is married. Bob is a consummate professional, well liked, respected by his peers. What an outrageous phone call.

When you arrive at work the next day at 7 am, the morning nursing report is abuzz. Several other people received the same anonymous phone calls. Bob is not on that shift, nor is Dr. Snuggles, so theres no way to address this matter right away. You get to work on the pile of papers on your desk. Late that day, you open your interoffice mail and a find a piece of paper that appears to have been printed on a computer. The large blocky font spells out: Bob and Dr. Snuggles are GAY.

You call Human Resources and get their voicemail recording. The entire department is at an offsite retreat for the day. Callers should try back tomorrow. You get busy with other burning issues and set the Dr. Snuggles matter aside.

At the end of your 10-hour day, you decide to close your office door and stay late to research the matter. You consult the Riverfront Medical Center policy manual. It does not forbid consensual sexual relations between coworkers. However, it does state that if a romantic relationship exists and one of the workers supervises the other, the couple must declare the relationship and find a way to move into different roles. Dr. Snuggles does not supervise Bob. You are Bobs supervisor. The policy manual is silent on same-sex relationships, except where it applies to benefits for domestic partners. They are not domestic partners. Dr. Snuggles is married to Mrs. Snuggles, a stay-at-home mother of two teenage twin boys who are seniors in high school.

Just as you think it might be a good idea to put your head in the sand and pray the rumor mill shuts down, you hear two people arguing in the conference room next door to your office.

Bobs voice pierces the wall. Im sick of being your work spouse, Snuggles. I want to be your real partner.

I told you, I have to wait until the boys are out of the house. This will be hard on them.

Ive been waiting for five years. Im tired of this charade. Im telling your wife.

Something slams into the wall and you jump to your feet. You run to the next room, throw the door open and find Dr. Snuggles and Bob in a passionate embrace.

So much for putting your head in the sand.

Discussion Questions
1.    What are the facts in this situation? What is known and not known so far?

2.    What is the nature of this organizational problem?

3.    What steps should be taken to investigate this further? Is this sexual misconduct? Have Dr. Snuggles and Bob violated any of Riverfront Medical Centers policies?

4.    Does it matter that Bob is a male, not a female RN?

5.    What is the role of the nurse manager in this scenario? What immediate action should she take? What longer term actions should she plan?

6.    What kind of clinical and financial impacts do you think Dr. Snuggles and Bobs behaviors might have for the hospital?

7.    Employee Assistance Programs (EAPs) exist to help employees with personal and family issues, including addictions. Should Dr. Snuggles and Bob be referred by HR to EAP?

8.    Have you ever been aware of a romantic liaison at work that made you uncomfortable? Provide your reflections and personal opinions as well as your recommendations for what could have been done differently in this case. Provide a rationale for your response.

Borkowski, N. (2011). Organizational behavior in health care (2nd ed.). Sudbury, MA: Jones and Bartlett.

Buchbinder, S. B., & Shanks, N. H. (Eds.). (2012). Introduction to health care management (2nd ed.). Burlington, MA: Jones & Bartlett.

Erwin, P. (2008, November 10). Seven signs you have a work spouse. Retrieved from

Fallon, L. F., & McConnell, C. R. (2007). Human resource management in healthcare: Principles and practices. Sudbury, MA: Jones and Bartlett.

The Free Dictionary by Farley. Retrieved from

Heinze, T., Kizirian, T., & Leese, W. (2004). Fraternization in accounting firms: A case study. Journal of College Teaching & Learning (TLC), 1(12), 6164.

Morrison, E. E. (2011). Ethics in health administration: A practical approach for decision makers (2nd ed.). Sudbury, MA: Jones and Bartlett.

Office of Minority Health. (2001). National standards for culturally and linguistically appropriate services in health care: Final report. Washington, DC: U.S. Department of Health and Human Services.

Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2004). Crucial confrontations. New York, NY: McGraw-Hill.

Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2011). Crucial conversations: Tools for talking when stakes are high (2nd ed.). New York, NY: McGraw-Hill.

Perez, B., & Liberman, A. (2010). Sexuality in the workplace: Where do we stand? The Health Care Manager, 29(2), 98116.

Rosenbury, L. (2011, October 5). Working relationships. Washington University Journal of Law and Policy, 35, 117147.

Salvaggio, A. N., Hopper, J., & Packell, K. M. (2011). Coworker reactions to observing sexual behavior at work. Journal of Managerial Psychology, 26(7), 604622.



* Hospital intensivist: Intensive care specialist. A hospital-based critical care physician who works primarily in an ICU. (Medical Dictionary. Retrieved from

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