Management in Health Care

This chapter provides a definition of management and leadership and discusses the general process of management. Management processes and roles frame all leadership activities. Broad areas of management skills and roles are then presented; the chapter concludes with a discussion of the problem-solving method (the scientific method for a leadership role). The content in this chapter forms the foundation for specific leadership responsibilities that are addressed in Part II of this book.

The management process and the problem-solving method are the procedures for all management responsibilities. These procedures outline how managers should function. Chapter 2 discusses the concepts and theories explaining why managers function in particular ways. This chapter also provides the rationale for the educational design of the book, the intent of which is to enable learners to grow and therefore change; change is synonymous with growing or learning. The goal of this book parallels the goal of health care managers and leaders, that leaders also facilitate change and growth in their personnel. The conceptual framework presented in this chapter applies to learning how to become a manager as well as to the role of being a manager. The conceptual framework, therefore, holds together the education of future leaders and managers as well as the process of management and leadership.

Chapter 3 focuses on diagnosing self since the manager is an important part of the environment, and diagnosing self is the first step of the equation for diagnosing the organizational environment. This diagnosis involves identifying the manager’s view of the problem/goal and of the unique environment, a viewpoint that will be influenced by the manager’s values and perceptions. The manager must also diagnose the behaviour style that is part of his or her leader personality—how the manager behaves involuntarily without cognitively thinking about actions. A discussion of the conceptual framework for diagnosing self begins this chapter.

The introduction to Part II contained a discussion of the human and material resources that must be considered when designating the system that will carry out a goal or solve a problem. Once a system is identified, it must be diagnosed.

This chapter contains a discussion of leader behaviour theory with an application of theory to the system diagnosis in order to determine the appropriate leader behaviour for a unique system that will achieve a goal.

Part II of this book is devoted to identifying the appropriate leader behaviour for motivating people in a system to accomplish a goal. This process involves diagnosing the environment—self, system, and task— and applying leader behaviour theory.

This chapter provides an application of the theory that has been presented in Chapters 1 through 6. A case example is studied by following the steps of the problem-solving method, each of which has been discussed in separate chapters. As a review, this problem-solving method involves:

In May 1922, 68 years ago, The American Academy of Political and Social Science devoted an entire issue to the ethics of the professions and business. It is clear that concern with ethics is far from new. However, it is the content of that concern that has changed so much over the years in the health field. The individual struggle with justice-right and wrong-remains essentially the same. Meanwhile, in the last two decades particularly, there has been mounting concern with the ethical management of society’s organizations. This concern ranges from national goverment to structures closer at hand, particularly the health care system. Specifically this chapter is concerned with menagement in the spectrum of organizations devoted to health and illness.

Everyone exerts influence on another—changes another—implicitly and explicitly, covertly and overtly. This fact is especially important in management and leadership. At an informal level, each time a person interacts with another by sending a message, the receiver’s response to the sender is shaped by the message received. In a sense, the receiver has formed a response to fit a message sent by another. The sender, therefore, has influenced the receiver. To influence another means that a person elicits something from another or engenders something in another. This is change, and recalling from previous chapters, change is learning, and learning is change. Humans do not interact in a vacuum; people are part of a system that exerts constant influence over individual behaviour. This is a sociologial perspective, of course, and contemporary management practice embraces this approach.

Managers and leaders must have knowledge about the phenomenon of power and be astutely able and willing to put its forces to work effectively in accomplishing specified goals. A manager without such ability and willingness is relatively impotent. The purpose of this chapter is to discuss power by first looking at various definitions of the concept. The types and sources of power followed by uses of power are then presented.

All managers and leaders are teachers. The purpose of teaching is to facilitate learning in another person. Learning is an intrinsic experience for the receiver. It denotes an integration of knowledge, attitudes, and experience in a person’s past and present (La Monica, 1985). When someone learns, change occurs in that individual. The manager’s primary goal is motivating others to accomplish goals. Managers should constantly be developing strategies to change what people would normally do if uninfluenced to what they need to do to accomplish the goals of an organization. To effect this change, followers must learn what the task requires; managers must facilitate this learning by teaching. Being a teacher is a subrole of being a manager. The intent of a teacher is to facilitate learning. The focus of this chapter is to discuss the teaching methods and processes that are available to managers.

The interview is the primary procedure used in data collection—this can be for varied purposes such as gathering information on a client for the nursing care plan or gathering information from potential and hired employees. On a smaller scale, a manager can interview an employee informally regarding a situational event.

Although the concepts underlying assertiveness training have been gaining increasing popularity, the usefulness of the training model to the helping professions was first noted in 1949. Originally conceived as a limited form of behaviour therapy (Salter, 1961; Wolpe, 1958), assertiveness training has been found to have so many applications that it can no longer be considered as a single technique, but rather as an array of techniques designed to be effective with a large and varied number of target populations (Shoemaker & Satterfield, 1977). Most of the strategies and techniques, however, rest on three basic assumptions about human nature (Percell, 1977):

Group dynamics involves the study and analysis of how people interact and communicate with each other in face-to-face small groups. The study of group dynamics provides a vehicle to analyse group communications with the intent of rendering the groups more effective (Davis & Newstrom, 1985; La Monica, 1985).

Every human being has a unique set of drives, goals, and needs that are constantly seeking satisfaction. Earth contains all of these individuals who move in various directions across time and space on their journeys. If these journeys could be thought of as self-contained capsules that floated around other capsules, then each would be autonomous, and humans could not be considered sociologically; general system theory would not be viable.

People plan within a boundary of time, look on the past over a span of time, and set goals for the future that are to be met within a period of time. Time can facilitate goal accomplishment, and it can be an oppressive force in finishing tasks. It can make people nervous in one context and can relax those same people in another context. Life is run on a time schedule—in some instances the schedule is philosophical, and in other instances it is concrete. For example, one has six months to live or one has a whole lifetime. Is there any philosophical difference in these statements? Clocks, calendars, watches, seasons, holidays, birthdays, and so forth, all point to time—the unidirectional process of growth.

Performance appraisal is one method for a manager to control what is occurring in the organization. It is a way to compare the outcomes of individual and group behaviours toward goal accomplishment with the initiatives that were planned. Further, it is the way most managers formally and informally guide employees in their professional development within an organization.

Job stress is one of the most common, yet least recognized or understood problems facing managers today. Some of this stress is relatively harmless. However, excessive stress can cause major problems. The purpose of this chapter is to discuss stress, the symptoms, various definitions, types of stress and finally its management.

There has been growing concern in the National Health Service (NHS) to improve aspects of health care since the early 1980s when the Griffiths Report (NHS Management Inquiry, 1983) placed explicit emphasis on quality as an agenda item. Since then serious attention has been given to the development of approaches and tools for the assessment of change with increasing pressure from the Department of Health to provide quality health care. As a result, a whole growth industry has evolved around the concept of “quality”, including quality assurance, quality assessment, quality control, and total quality management. And while considerable controversy surrounds the meaning of such terms, the general consensus is that the health service needs to focus on improving the quality of its health care to patients. There is less agreement on how this might be achieved. Nevertheless, quality health care together with total quality management (TQM) has emerged as a watchword for health care in the 1990s. This chapter discusses the relevance of total quality management, as it pertains to the health service.

In order to provide a basic understanding of the various concepts discussed so far it may be useful at this juncture to discuss the managerial processes in terms of a larger contextual framework. For convenience we can call this wider framework the “environment”.

Donabedian (1980) has noted that an organization’s structure “is probably the most important means of protecting and promoting the quality of care”. In structuring an organization, management must select from among several design options those elements that appear to have the optimum chance of achieving the organization’s purpose. In making this selection, management must steer a difficult course between the demands of the environment and the needs of employees. Doing this requires: (1) a clear understanding of the organization’s goals, strategy, and people; and (2) a thorough understanding of the various design components available.

The importance of culture in determining an organization’s effectiveness has received widespread attention in recent years. While not an entirely new concept—it has been discussed in the literature for over 100 years— it has been given a new impetus by the “excellence writers” exemplified by the work of Ouchi (1981), Peters and Waterman (1982), Deal and Kennedy (1982), and Pascale and Athos (1982). The common theme among these popular, best-selling authors is the emphasis they place on the part played by shared values and beliefs in shaping successful organizations.