Managing the Healthcare Organization

 

Griffith and White (2007) list the following concepts to transcend a stakeholder agreement into effective action: Service excellence, accountability, continuous improvement, epidemiologic planning, and transformational management.

 

How does a transformational leader affect an organization’s vision, organizational culture, and emotions/attitudes?

 

 Leadership

 

• Describe the elements of transformational leadership and its affect in organizations.

 

The elements of transformational leadership include (a) creating a vision, (b), communicating the vision, (c) modeling the vision, and (d) building commitment to the vision (McShane & Von Glinow, 2004a). When creating a vision, a transformational leader’s objective is to unify employees and other stakeholders toward a common goal for the company. The strategic vision represents the desired future state of the organization. The vision serves as a means to motivate organizational members to strive to meet the objectives to obtain this desired future state.

 

McShane and Von Glinow (2004a) asserted, “If vision is the substance of transformational leadership, then communicating that vision is the process” (Communicating the Vision section, ¶ 1). When communicating the vision, transformational leaders elevate the importance of and use emotional appeal to beguile employees and other stakeholders to “buy-in” into the vision and to act collectively to reach the desired future state.

 

The cliché “actions speak louder than words” is of important significance for a transformational leader that has a strategic vision. In other words, a transformational leader must model or align his/her actions with that of the vision. McShane and Von Glinow (2004a) proclaimed, “Modeling the vision is important because employees and other stakeholders are executive watchers who look for behaviors to symbolize values and expectations” (Modeling the Vision section, ¶ 1). Credibility is lost if a transformational leader’s actions conflict with the stated vision. When this happens, employee and other stakeholder trust are lost, along with the vision.

 

How does a visionary leader build commitment to the vision? One way is to involve employees and other stakeholders in the process of realizing the vision. Building enthusiasm invigorates others to embrace the vision as their own. Employee commitment is essential to realize the vision; therefore, a transformational leader must enact his/her vision and demonstrate tenaciousness and steadiness in his/her commitment to the vision.

 

Culture

 

• How can leaders change a culture?

 

A leader can change an organization’s culture by realigning cultural values with the inherit changes of the organization. One way to reinforce a new corporate culture is through the use of artifacts. McShane and Von Glinow (2004) defined artifacts as “observable symbols and signs of an organization’s culture” (Deciphering Organizational Culture through Artifacts section, ¶ 1). Examples of artifacts include employee rewards, the physical layout of the work environment – whether the work environment supports interaction and teamwork or seclusion from other workers, and/or the methods used when interacting with customers. A leader needs to make employees aware that cultural change is eminent. By removing the artifacts of the old culture and introducing artifacts of the new culture allows leaders to reinforce the new and desired values.

 

In addition to new artifacts that convey and support the new corporate culture, McShane and Von Glinow (2004b) outlined five approaches to strengthen an organization’s culture to include (a) the actions of founders and leaders, (b) introducing culturally consistent rewards, (c) maintaining a stable workforce, (d) managing the cultural network, and (e) selecting and socializing new employees” (Strengthening Organizational Culture section, ¶ 1). Establishing a workforce that has compatible beliefs, values, and assumptions to that of the organization helps create a new corporate culture. McShane and Von Glinow (2004b) asserted … “a good fit of personal and organizational values makes it easier for employees to adopt the corporate culture” (Selecting and Socializing section, ¶ 2). Additionally, promoting organizational socialization assists employees to practice the expected values and core beliefs. In order for this to happen, employees must demonstrate enacted values as opposed to espoused values. “Espoused values do not represent an organization’s culture. Rather, they establish the public image that corporate leaders want to display. Enacted values, on the other hand, are values in use” (McShane & Von Glinow, 2004b, Elements of Organizational Culture section, ¶ 2).

 

First, before an employee is hired, it is essential that the organization’s values, beliefs, and expectations be communicated. An effective way to communicate organizational values, beliefs, and expectations is through established employees. Assigning a new hire a mentor or preceptor that (a) demonstrates positive affectivity (PA); (b) practices the organizational values, beliefs, and expectations; and (c) provides social support for the new hire helps to “ease the transition” of the new hire into the organization culture.

 

It is also important to ensure that the employee is a “good fit” for the organization. A leader must present a realistic-job preview (RJP) to avoid reality shock. McShane and Von Glinow (2004b) described reality shock as “perceived discrepancies between pre-employment expectations and on-the-job- reality” (Stage 2: Encounter section, ¶ 10). A RJP provides potential employees a realistic view of both the positive and negative aspects of the work environment. A RJP may cause some applicants to reconsider employment; however, if an employee knows what to expect before accepting the position he/she applied, the likelihood of developing an affective organizational commitment as opposed to a continuance organizational commitment is more probable. An employee who demonstrates affective commitment has increased levels of job satisfaction and loyalty. This transcends into decreased employee turnover.

 

 

Attitudes and Emotions

 

• What is the relationship between emotions, attitudes, and behavior?
• What is emotional intelligence and why is it important to leaders?

 

A person's emotions and attitudes (judgments) about their work environment make a difference in an employee’s behavior, a company's performance, a customer loyalty, and an employee well-being. Therefore, companies need to find creative ways to generate positive emotions at work. Since emotions (experiences) affect different aspects of workplace behavior, it is important to realize how attitudes (judgments) - comprised of beliefs, feelings, and behavioral intentions - are linked to long-term feelings about the company. McShane and Von Glinow (2004c) stated,

 

First we calculate our feelings from our beliefs. This process is known as the expectancy-value model, says that feelings are determined by the person's beliefs about the attitude object's expectancy of producing specific outcomes as well as by the value (good or bad) of those outcomes. (Emotions, Attitudes, and Behavior section, para. 4)

 

Additionally, feelings influence a person's behavioral intentions. Based on past experiences, a person may display varied behavioral intentions. How does a leader influence or predict these behavioral intentions? Through a process called emotional labor, a leader can put forth the effort, initiate a plan, and establish the control needed to express organizationally desired emotions. This requires a leader to posses emotional intelligence (EI), which encompasses "the ability to perceive and express emotion, assimilate emotion in thought, understand and reason with emotion, and regulate emotion in oneself and others" (McShane & Von Glinow, 2004c, Emotional Intelligence section, para. 2). Components of EI include self-awareness, self-management, social awareness, and relationship management.

 

McShane, S. & Von Glinow, M. (2004a). Organizational behavior: Leadership in organizational settings (3rd ed.). New York: McGraw-Hill.

 

McShane, S. & Von Glinow, M. (2004b). Organizational behavior: Organizational culture (3rd ed.). New York: McGraw-Hill.

 

McShane, S. & Von Glinow, M. (2004c). Organizational behavior: Workplace emotions and attitudes (3rd ed.). New York: McGraw-Hill.

Which of the concepts below can be used by effective managers to help speed consensus building?

Do you agree that management is responsible for answering work team questions?  Many of these questions deal with support issues (e.g. late, not enough, need a new model, no training) about the needs shown in Figure 4.1. How do excellent managers respond to these questions?

I take the position that answering team questions is necessary to prepare the best individuals for succession planning.   Every day is another day to learn something.  It is the daily activities that enable the student to experience real-time application of methods acquired in classroom training.  Management has the responsibility for the organization to provide support to frontline work teams.  However, management also has the prerogative to determine in what way to respond to work teams.   The first and last line for management and work teams is in promotion of the organizational mission.  Figure 4.1 shows the types of support teams need to accomplish the organizational mission.   As the text points out “high performing organizations have change their approach to the environment, putting much more emphasis on measured performance, empowerment, learning, responsiveness to all stakeholder needs, and continuous improvement.”   Management and work teams are continually engaged in the change process using all available tools toward achieving outcomes desired by their customers as well as establishing and maintaining the services excellence culture and chain described in the text (chapter 4).  Additionally, management involvement in work teams should purposefully peruse the work team for individuals who may be mentored for succession within the organization.  Therefore, I think answering work team questions is within the purview of management along with the method of how those questions should be addressed.

I attended an interesting discussion the other day about physician satisfaction and willingness to refer.  We have very strong physician satisfaction scores, but when then asked about willingness to refer the scores are somewhat lower.  Historically, strong physician satisfaction has equalled a strong willingness to refer, but we seem have a gap.<p>I'm wondering where others have focused their efforts to remove barriers as it relates to "willingness to refer".

We just recently completed our associate opinion survey.  We had a lot of changes last year most specifically in associate benefits as result of a moderate change in benefits such as health insurance and deductibles we were hit hard as a HCO on this subject as far as significant decrease in associate satisfaction. In some of my service lines this has also impacted day to day happiness within some of my departments. Some of this unhappiness is due to manager's developmental needs.  I was just wondering if anyone else had done an assoicate opinion survey and what is the current climate like in your organization. Also does anyone have any ideas on improving assoicate everyday happiness that are cost effective duiring these turbulent financial times.

What survey tools/methods do you use to assess stakeholder satisfaction? We use Press Ganey for employee, medical staff and house staff satisfaction and are able to get national comparative data. The gap we have is in assessing referring physician satisfaction which is now done on a biannual survey and followed up on via focus groups. Does anyone have suggestions on a more effective and timely process for this assessment?

Who does you orginization consider "senior management"?  How big is the group?  Is it just the C-level people?  Is it senior managers?

 

 Also if it just the C-level people or VP etc, is there a working group of middle managers?