Org Behavior

Cultural Competence

"Culture" refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. "Competence" implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities (HHS Office of Minority Health)

three areas that are key organization-specific factors for shaping career outcomes for women and racially/ethnically diverse individuals:

(1) leadership and strategic orientation (i.e., senior management's commitment to successful implementation of diversity initiatives), (2) organizational culture/climate (i.e., the depth and breadth of the organization's strategic commitment to diversity leadership and cultural competence), and (3) human resources practices (i.e., establishing best practices in advancing the management careers of women and racially/ethnically diverse individuals, such as formal mentoring programs, professional development, work/life balances, and flexible benefits).

Hersey and Blanchard's Situational Leadership Model

(see Figure 10-4), as the employee cultivates knowledge, skills, and abilities to perform at increasing levels of expectations, the manager modifies his or her leadership style. As the subordinate passes through different stages of commitment 200 201 and competence, the leader varies the amount of direction and support given. The leader plays various roles of directing, coaching, supporting, and delegating as the subordinate "matures" and becomes able to perform more activities. The varying amounts of direction and support given are conceptualized into four leadership styles: Telling, Selling, Participating, and Delegating.

For healthcare managers to transform their organizations into an inclusive culture where all employees feel the opportunity to reach their full potential, Guillory (2004, pp. 25-30) recommended a ten-step process:

1.Development of a customized business case for diversity for your organization. In other words, how does diversity relate to the overall success of the organization? 2.Education and training for your staff to develop an understanding of diversity, its importance to your organization's success, and diversity skills to apply on a daily basis. 3.Establishment of a baseline by conducting a comprehensive cultural survey that integrates performance, inclusion, climate, and work/life balance. 4.Selection and prioritization of the issues that lead to the greatest breakthrough in transforming the culture. 5.Creation of a three- to five-year diversity strategic plan that is tied to organizational strategic business objectives. 6.Leadership's endorsement of and financial commitment to the plan. 7.Establishment of measurable leadership and management objectives to hold managers accountable to top leadership for achieving these objectives. 8.Implementation of the plan, recognizing that surprises and setbacks will occur along the way. 9.Continued training in concert with the skills and competencies necessary to successfully achieve the diversity action plan. 10.Survey one to one-and-a-half years after initiation of the plan to determine how inclusion has changed.

OMH has developed a list of 14 standards for Culturally and Linguistically Appropriate Services

1.Promote and support the attitudes, behaviors, knowledge, and skills necessary for staff to work respectfully and effectively with patients and one another in a culturally diverse work environment. 2.Have a comprehensive management strategy to address culturally and linguistically appropriate services, including strategic goals, plans, policies, procedures, and designated staff responsible for implementation. 3.Utilize formal mechanisms for community and consumer involvement in the design and execution of service delivery, including planning, policy-making, operations, evaluation, training, and, as appropriate, treatment planning. 4.Develop and implement a strategy to recruit, retain, and promote qualified, diverse, and culturally competent administrative, clinical, and support 24 25 staff that are trained and qualified to address the needs of the racial and ethnic communities being served. 5.Require and arrange for ongoing education and training for administrative, clinical, and support staff in culturally and linguistically competent service delivery. 6.Provide all clients with Limited English Proficiency access to bilingual staff or interpretation services. 7.Provide oral and written notices, including translated signage at key points of contact, to clients in their primary language, informing them of their right to receive no-cost interpreter services. 8.Translate and make available signage and commonly used written patient educational material and other materials for members of the predominant language groups in service areas. 9.Ensure that interpreters and bilingual staff can demonstrate bilingual proficiency and receive training that includes the skills and ethics of interpreting, as well as knowledge in both languages of the terms and concepts relevant to clinical or nonclinical encounters. Family or friends are not considered adequate substitutes, because they usually lack these abilities. 10.Ensure that the clients' primary spoken language and self-identified race/ethnicity are included in the healthcare organization's management information system, as well as any patient records used by provider staff. 11.Use a variety of methods to collect and utilize accurate demographic, cultural, epidemiological, and clinical-outcome data for racial and ethnic groups in the service area, and become informed about the ethnic/cultural needs, resources, and assets of the surrounding community. 12.Undertake ongoing organizational self-assessments of cultural and linguistic competence, and integrate measures of access, satisfaction, quality, and outcomes for CLAS into other organizational internal audits and performance-improvement programs. 13.Develop structures and procedures to address cross-cultural ethical and legal conflicts in healthcare delivery and complaints or grievances by patients and staff about unfair, culturally insensitive, or discriminatory treatment, difficulty in accessing services, or denial of services. 14.Prepare an annual progress report documenting the organization's progress with implementing CLAS standards, including information on programs, staffing, and resources.

Commonwealth Fund Program Goals

1.Understand that patients and healthcare professionals often have different perspectives, values, and beliefs about health and illness that can lead to conflict, especially when communication is limited by language and cultural barriers. 2.Become familiar with the types of issues and challenges that are particularly important in caring for patients of different cultural backgrounds. 3.Think about each patient as an individual, with many different social, cultural, and personal influences, rather than using general stereotypes about cultural groups. 4.Understand how discrimination and mistrust affect the interaction of patients with physicians and the healthcare system. 5.Develop a greater sense of curiosity, empathy, and respect toward patients who are culturally different, and thus be encouraged to develop better communication and negotiation skills through ongoing instruction.

Communication Networks

A communication network is the interaction pattern between and among group members. A network creates structure for the group because it controls who can and should talk to whom (Keyton, 2002). Groups generally develop two types of communication networks: centralized and decentralized (Figure 4-4). Decentralized networks allow each group member to talk to every other group member without restrictions. An open, all-channel or decentralized network is best used for group discussions, decision making, and problem solving. The all-channel network tends to be fast and accurate compared with the centralized network such as the chain or Y-pattern networks (Longest et al., 2000). Nevertheless, a decentralized network can create communication overload, in which too much information or too complex communication may occur (Keyton, 2002). When a communication overload is produced, messages may conflict with one another and result in confusion or disagreement. To reduce communication overload, a facilitator should be used to monitor group discussions. A centralized network restricts the number of individuals in the communication chain. In a group setting where a dominant leader takes over group discussions by controlling the number of messages and amount of information being passed, group members do not interact except through the leader. Such a network can create communication underload, in which too few or simple messages are transmitted. In this type of network, group members feel isolated from group discussions and generally feel dissatisfied. In the chain network, communication occurs upward and downward and follows line authority relationships.

Compliance Officer

After Paul left, Ben knew he had to do something immediately. Although Harry Benson had been responsible for developing and implementing all the necessary policies and procedures to prevent medical errors, Harry was not doing enough and things were going to have to change—now! He would deal with Harry later, but his first priority was creating a new position—Chief Safety and Compliance Officer. This new position would report directly to him and would have full authority to do whatever was needed to ensure that these problems did not occur again. He immediately drafted the job description. The selected candidate will play a key role in the development of the organization's compliance culture with a focus on prevention. This position will be responsible for developing, implementing, and communicating the organization's compliance and safety standards, policies, and procedures. The position will oversee the design, organization, and implementation of systemwide compliance education and training programs. The position is responsible for monitoring and evaluating compliance activities to ensure program goals are being met across all functional areas. The position is responsible for establishing and participating in internal disciplinary actions for compliance violations. The candidate must have an MHA or related degree, 10 years of experience in the safety and compliance area, including seven years in the healthcare industry and five years in a managerial role. The position offers a competitive

Attitude

Allport (1935) defined an attitude as a mental or neural state of readiness, organized through experience, exerting a directive or dynamic influence on the individual's response to all objects and situations to which it is related. A simpler definition of attitude is a mind-set or a tendency to act in a particular way toward an object or entity (i.e., person, place, or thing) due to both an individual's experience and temperament. An attitude includes three components: an affect (a feeling), cognition (a thought or belief), and behavior (an action). Alfred Adler (1870-1937), a Viennese physician who developed the theory of Individual Psychology, emphasized that a person's attitude toward the environment had a significant influence on his or her behavior.

Effective Communication

Although managers spend most of their time communicating (e.g., sending or receiving information), one cannot assume that meaningful communication occurs in all exchanges (Dunn, 2006). Once a memorandum, letter, fax, or e-mail has been sent, many are inclined to believe that communication has taken place. However, communication does not occur until information and understanding have passed between sender and the intended receiver. For example, a receiver may hear a sender but may not have comprehended the sender's actual meaning. Effective communication occurs when the message received is the same as the one intended. Communication enables one to establish and maintain positive interactions in the workplace. An effective communicator overcomes barriers to engage in more meaningful and successful communication. The message originates from the sender who uses words and symbols to put forth information into a message for the receiver, the individual(s) receiving the message. Messages are then received and decoded or interpreted by the receiver. Decoding is affected by the receiver's prior experiences and frames of reference. Accurate decoding of the message by the receiver is critical to effective communication. The closer the decoded message gets to the intent of the sender, the more effective the communication. Feedback is the destination's reaction to a message (Certo, 1992). It is an important element of communication since it allows for information to be shared between the receiver and sender in a two-way communication. To be effective, communication must allow opportunities for feedback. Feedback can take several forms, each with a different intent. Keyton (2002) describes three different forms of feedback: descriptive, evaluative, and prescriptive. As a managerial tool, feedback enables managers to anticipate and respond to changes. Structured feedback enhances managerial planning and controlling functions. Because of the value of feedback, managers should encourage feedback and evaluate it systematically. Employees are the organization's brain cells, and communication represents the nervous system that carries information and shared meaning to vital parts of the organizational body. Effective communication brings knowledge into the organization and disseminates it to employees who require that information. Effective communication minimizes the "silos of knowledge" problem that undermines an organization's potential and, in turn, allows employees to make more informed decisions about corporate actions. Effective communication is one of the most critical goals of organizations (Spillan et al., 2002). Research suggests that an effective manager is one who spends considerable time on staffing, motivating, and reinforcing activities (Luthans et al., 1988). An effective communicator must have a desire to communicate, which is influenced both by one's personal values and the expectation that the communication will be received in a meaningful way. An effective communicator must have an understanding of how others learn, which includes consideration of differences in how others perceive and process information (e.g., analytic versus intuitive, abstract versus concrete, verbal versus written). •The receiver of the message should be cued as to the purpose of the message, that is, whether the message is to provide information, elicit a response or reaction, or arrive at a decision. •The content, importance, and complexity of the message should be considered in determining the manner in which the message is communicated. •The credibility of the sender affects how the message will be received. •The time frame associated with the content of the message (long versus short) needs to be considered in choosing the manner in which the message is communicated. More precise cues are needed with shorter time frames (see Figure 4-3).

Hofstede's Cultural Dimensions

An extensive cross-cultural survey. was conducted over an 11-year period, with more than 116,000 respondents in more than 40 countries. The researcher collected data about "values" from the employees of a multinational corporation located in more than 50 countries. Individualism-Collectivism: Individualism-collectivism measures culture along a self-interest versus group-interest scale. Individualism stands for a preference for a loosely knit social framework in society wherein individuals are supposed to take care of themselves and their immediate families only. Its opposite, collectivism, stands for a preference for a tightly knit social framework in which individuals can expect their relatives, clan, or other in-group to look after them in exchange for unquestioning loyalty. Hofstede (1983) suggested that self-interested cultures (e.g., individualism) are positively related to the wealth of a nation. •Power Distance: Power distance is the measure of how a society deals with physical and intellectual inequalities, and how the culture applies power and wealth relative to its inequalities. People in large Power Distance societies accept hierarchical order in which everybody has a place, which needs no further justification. People in small Power Distance societies strive for power equalization and demand justification for power inequalities. Hofstede (1983) indicated that group interest cultures (e.g., Collectivism) have large Power Distance. •Uncertainty Avoidance: Uncertainty Avoidance reflects the degree to which members of a society feel uncomfortable with uncertainty and ambiguity. The scale runs from tolerance of different behaviors (i.e., a society in which there is a natural tendency to feel secure) to one in which the society creates institutions to create security and minimize risk. Strong Uncertainty Avoidance societies maintain rigid codes of belief and behavior and are intolerant toward deviant personalities and ideas. •Weak Uncertainty: Avoidance societies maintain a more relaxed atmosphere in which practice counts more than principles and deviance is more easily tolerated. Masculinity Versus Femininity: Masculinity versus femininity measures the division of roles between the genders. The masculine side of the scale is a society in which the gender differences are maximized (e.g., need for achievement, heroism, assertiveness, and material success). Feminine societies are ones in which there are preferences for relationships, modesty, caring for the weak, and the quality of life.

Galatea Effect (Believe in yourself.)

An individual's high self-expectations lead to high performance. James Sweeney was an industrial management professor at Tulane University who wished to disprove the theory that a certain IQ level was needed to learn how to program computers. Sweeney trained a poorly educated janitor whose IQ indicated that he would be unable to learn to type, much less program. The janitor not only learned to program, but also eventually took charge of the computer room along with the responsibility of training new employees to program and operate the computers. As Livingston pointed out, Sweeney's expectations were based on what he believed about his teaching ability (internal expectations), not on the janitor's learning capabilities. Livingston related that, "the high expectations of superior managers are based primarily on what they think about themselves—about their own ability to select, train, and motivate their subordinates. What the manager believes about himself subtly influences what he believes about his subordinates, what he expects of them, and how he treats them" (Livingston, 1969).

Attribution Theory

Attribution theory was first introduced by Heidler (1958) as "naive psychology" to help explain the behaviors of others by describing ways in which people make casual explanations for their actions. Heidler believed that people have two behavioral motives: (1) the need to understand the world around them and (2) the need to control their environment.

Leadership styles

Authoritarian: The authoritarian leader remained aloof and used orders (without consultation) in directing the group's activities. Democratic: The democratic leader offered guidance and encouraged the children while actively participating in the groups' activities. Laissez-Faire: The laissez-faire leader gave the children knowledge, but did not direct the activities, nor did this leader become involved or participate in the groups' activities. Note certain people are preferential toward certain types of leadership

Generation X and Y

Barney (2002, p. 83) points out that Generation-X workers (individuals born between 1965 and 1976) want "managers who listen, consider their ideas, and treat them as peers. They want to be part of the decision-making process and want flexibility in their work environment because they value their time and freedom." Generation-Y, individuals born between 1977 and 1995, have begun to enter the workforce. Generation-Y will be the fastestgrowing segment of the workforce. Although it is impossible to generalize about the wants and needs of millions of people in each generation, workplace experts tend to use the following characteristics to describe Generation-Y (Martin & Tulgan, 2006): •High expectations of self: They aim to work faster and better than other workers. •High expectations of employers: They want fair and direct managers who are highly engaged in their professional development. •Ongoing learning: They seek out creative challenges and view colleagues as vast resources from whom to gain knowledge. •Immediate responsibility: They want to make an important impact on day one. •Goal oriented: They want small goals with tight deadlines so they can build up ownership of tasks.

Cognitive Resource theory

Cognitive resource theory states that: (1) a leader's intellectual abilities correlate positively with performance under low stress but negatively under high stress and (2) a leader's experience correlates negatively with performance under low stress but positively under high stress. For example, leaders under stress will fall back on their previously learned knowledge and behavior (e.g., relying on intuition and hunches); therefore, the greater the range of their experience, the better their performance. Under low-stress conditions, more experienced leaders are not challenged and tend to be bored and cut corners (Fiedler, 1996). Although this theory is relatively new, it is developing a solid body of research support (Robbins, 2001).

Past changes and future trends / challenges/ important topics in HC

Declining reimbursement for services Technology Biomedical & genetic research Increased govt mandates Increase focus on chronic disease management Greater need for home health and LTC Patients are better informed and understand care starts with them Economics in a state of flux Staff shortages Terrorism emergence of new diseases, reemergence of old ones, and evolution of pathogens immune to many of today's medications Uninsured

Barriers to Communication

Environmental or Personal Environmental barriers are characteristic of the organization and its environmental setting. Personal barriers arise from the nature of individuals and their interaction with others. Both barriers can block, filter, or distort the messages when sent and received. overcoming barriers: 1.Environmental barriers are reduced if receivers and senders ensure that attention is given to their messages and that adequate time is devoted to listening to what is being communicated. 2.A management philosophy that encourages the free flow of communication is constructive. 3.Reducing the number of links (levels in the organizational hierarchy or steps between the sender in the healthcare organization and the receiver who is an external stakeholder) diminishes opportunities for distortion. 4.The power/status barrier can be removed by consciously tailoring words and symbols so that messages are understandable; reinforcing words with actions significantly improves communication among different power/status levels. 5.Using multiple channels to reinforce complex messages decreases the likelihood of misunderstanding.

Healthcare Organizations & their Communities

For effective communication to take place, realistic expectations must be formed by both parties. There are six areas of responsibility toward their communities for healthcare organizations (Longest et al., 2000). They include: 1.Engaging in the core, health-enhancing activities in the community. 2.Providing economic benefits to the community. 3.Offering unique benefits or a niche to the community. 4.Pursuing philanthropic activities in a broad and generous manner. 5.Being in full compliance with legal requirements. 6.Meeting ethical and fiduciary obligations.

Why I'd be a good compliance officer

I like making sure people are doing things correctly but also making sure they are appropriately trained and have adequate resources to do things correctly.

Informal Communication

In addition to formal communication flows and networks within healthcare organizations, there are informal communication flows, which have their own networks. Employees have always relied on the oldest communication channel—the corporate grapevine. The grapevine is an unstructured and informal network founded on social relationships rather than organizational charts or job descriptions. According to some estimates, 75 percent of employees typically receive news from the grapevine before they hear about it through formal channels. A manager's responsibility is to utilize the informal network selectively to benefit the organization's goals.

Ohio state leadership studies

In other words, consideration for workers and initiating structure existed simultaneously and to different degrees.

Kelley's Attribution Theory (Helps determine if an employee's problem / mistake is related to internal factors / the individual or if the problem is related to external factors.)

Kelley's (1967, 1973) model of attribution theory incorporates three attributions: consensus, consistency, and distinctiveness (see Figure 3-4). Consensus relates to whether an employee's performance is the same as or different from other employees. Consistency refers to whether the employee's behavior is the same in most situations. Whereas distinctiveness asks the question, "Does the employee act differently in other situations?" Managers will attribute an employee's behavior to external causes such as task difficulty if there is high consensus, low consistency, and high distinctiveness. As an example, the regional director of an international pharmaceutical company attributes her top salespersons' inabilities to reach their annual sales goals for a specific drug used to treat gastrointestinal conditions to recent negative media coverage of another, but similar drug's linkage to a high number of patients suffering strokes (e.g., adverse effects to the drug). Managers will attribute an employee's behavior to internal factors, such as lack of ability, if there is low consensus, high consistency, and low distinctiveness.

Managers vs Leaders

Kotter (1988) believes that managers and leaders perform two distinctive but complementary activities. Winder (2003) and Hellriegel, Slocum, and Woodman point out that a manager is a person who directs the work of employees and is responsible for results. By contrast, a leader inspires employees with a vision and helps them cope with change. Leaders make people want to achieve an organization's goals and objectives, while managers direct people to accomplish a particular task or objective. In the words of Peter Druker and Warren Bennis, "Management is doing things right; leadership is doing the right things.

Changing attitudes within an organization

Managers need to understand that attitude change takes time and should not set unrealistic expectations for rapid change (Moore, 2003) 1.Assessment of Attitudes (a)Identification—Recognize common workplace attitude problems (b)Environment—Identify challenges in the workplace environmentParticipants are introduced to common examples of "attitude-challenged" workers. Group activities help identify and role-play how to handle different types of attitude challenges. Focus is to assess the impact of negative attitudes on workers, management, and patients/customers and identify the causes of problems. 2.Adjusting Attitudes (a)How listening, coaching, and providing feedback are the tools for attitude change. (b)Role-play to practice how to use coaching and provide feedback with staff (c)Identify payoffs and rewardsParticipants learn how to use open-ended questions, active listening, and tactful confrontation to address attitude problems in the workplace. 3.Common Management Mistakes (a)How to be realistic and patient with attitude change (b)Why scolding employees does little to stop the problem (c)How to stop the culture of complaining and work to positively effect attitude change. Group activities include examples of common management mistakes and exercises to practice more realistic and positive ways to provide employee feedback, facilitate group discussion, and role-play the best methods for confronting negative attitudes. 4.Resolving Conflict (a)The need to confront so that negative behaviors will not continue (b)Expectations and coping strategies of employees to stress and management directives (c)Recognizing personal conflict styles of workers and how to deal with them Exercises include ways to analyze communications to identify employee styles, planning the meeting, and working collaboratively to discover win/win solutions. 5.How to Work with Problem Behaviors and Attitudes (a)Analyze the cause of the problem (b)Privately confront with a calm, nondefensive professional demeanorIn this session, participants role-play with their preferred style for handling difficult employees. Managers and employees exchange roles and must reprimand or confront problem behaviors. 6.The Last Resort: Employee Termination and Legal Issues (a)Legal issues of employee terminations (b)Requirements, documentation, and procedureExercises use case studies to work out remedial and probationary systems and to document fully intervention efforts prior to the need for termination or re-assignment. 7.Creating a Positive Work Environment (a)Evoke a positive, collaborative team environment (b)Top motivators include nonmonetary rewards (c)Characteristics of managing motivation in the workplaceExercises include engaging workers into teams, providing recognition awards for employees, and changing the climate by launching career development and advancement initiatives, leadership training, multicultural skills, and other positive incentive programs.

Maslow's Hierarchy of Needs

Most people's (employee's) basic needs are met. They therefor have higher needs where money is no longer a sole motivation to perform well.

Leadership traits

One researcher studied a large number of North American organizations and leaders and came to the conclusion that there were some traits that did appear commonly. If a leader possessed these traits, he or she could lead in different situations. Physical vitality and stamina Intelligence and action-oriented judgment Eagerness to accept responsibility Task competence Understanding of followers and their needs Skill in dealing with people Need for achievement Capacity to motivate people Courage and resolution Trustworthiness Decisiveness Self-confidence Assertiveness Adaptability/flexibility

Path-Goal Leadership Theory

Path-Goal Leadership Theory (House, 1971) suggests that effective leaders provide the path, the support, and resources to assist subordinates in attaining organizational goals. Four separate, but fully integrated, components make up House's Path-Goal Leadership Theory: Leadership Behaviors, Environmental Contingency Factors, Subordinate Contingency Factors, and Outcomes (see Figure 10-2). The first component, Leadership Behavior, identifies four specific leadership styles: 1.The directive leader provides employees a detailed understanding of expectations, a plan to accomplish those expectations, and the resources to achieve the tasks. The directive leadership style can increase employee motivation and satisfaction where role ambiguity exists. 2.The supportive leader shows concern for people, ensuring the work environment does not impede specific tasks that lead toward organizational goals, and creates a supportive atmosphere. The supportive leadership style may increase employee motivation and satisfaction where tasks are routine or stressful. 3.The participative leader seeks input from a multiplicity of internal sources, including the technical core of employees, to assist in the decision-making process. The participative leader maintains responsibility for the final decision, but includes the workforce in the process, ultimately enhancing buy-in from affected parties. The participative leadership style can improve motivation and satisfaction in environments that are uncertain or in the process of change. 4.The achievement-oriented leader establishes stimulating goals and expects high levels of performance in achievement of the stated goals. The achievement-oriented style of leadership creates an environment of trust, where the leader acknowledges the workforce's abilities to accomplish organizational goals. House proposed that leadership styles are adaptable and that managers may be called upon to utilize any one of the four identified styles of leadership, depending on the situation (Razik & Swanson, 1995; Robbins, 2001). Leadership style is dependent on two contingency factors: environmental and subordinate. House considered external dynamics, which are referred to as environmental contingency factors. These factors include: (1) clarity of the task to be performed, (2) hierarchical authority systems, and (3) group dynamics (i.e., work-group members' relationships). These factors are generally considered to be outside the control and influence of the worker and the manager. The second set of contingency factors, considered internal dynamics, are referred to as subordinate contingency factors. These factors include the employee's locus of control; knowledge, skills, and abilities (real or perceived); and experience. Subordinate contingency factors are characteristics exhibited by the employees (Robbins, 2001). The integration of leadership style, environmental contingency factors, and subordinate contingency factors leads to outcomes (performance and satisfaction). According to House and Mitchell (1974), a leader's role is to influence subordinates' perceptions and motivate them toward achieving the desired outcomes (i.e., performance and satisfaction). To be effective, managers should: 1.Increase personal payoffs to subordinates for work goal attainment; 2.Provide coaching and direction, when needed; 3.Clarify expectations of workers; 4.Reduce frustrating barriers; 5.Increase opportunities for personal satisfaction contingent on effective performance. The appropriate leadership style that a manager should use is the one that compensates for any item absent from the employee (i.e., experience, ability) or the work setting (i.e., task structure). The leadership style should not duplicate what the employee already has available to him or her. For example, the nurse manager should not provide direction (i.e., directive leadership style) as to how to complete a patient's history and physical to a nurse with 20 years of experience. However, the nurse manager should provide direction and/or training to a nurse with 20 years of clinical experience but no experience with technology or electronic medical records as to how to complete a patient's history and physical if they are being done for the first time electronically.

Power

Power exists only when there is an unequal relationship between two people and where one of the two is dependent upon the other. Ex: Healthcare providers are dependent on the federal government, specifically the Medicare and Medicaid programs, for reimbursements. Any change in the levels of reimbursement can have either positive or negative effects on the industry.

Selective Perception - Broadbent Theory (Such as selective hearing, selective recognition of facts, etc. to support one's own agenda.)

Selective perception occurs when an individual limits the processing of external stimuli by selectively interpreting what he or she sees on the basis of beliefs, experience, or attitudes. Broadbent's filter theory has been updated in recent years. A "Selection-for-Action View" suggests that filtering is not just a consequence of capacity limitations but is driven by goal-directed actions (Allport, 1987, 1993; Neumann, 1987; Van der Heijden, 1992). The concept is that any action requires the selection of certain aspects of the environment that are action relevant and, at the same time, filtering other aspects that are action irrelevant. Therefore, when one is working toward a goal, one will skip over information that does not support one's plan.

Self-Handicapping (for excuses or bragging rights!)

Self-handicapping is where people place obstacles in their way, so if they do not succeed they can blame the obstacles or if successful, they can brag regarding their successful performance in spite of these barriers.

Social perception

Social perception is how an individual "sees" others and how others perceive an individual. This is accomplished through various means, such as classifying an individual on the basis of a single characteristic (halo effect), evaluating a person's characteristics by comparison to others (contrast effect), perceiving others in ways that really reflect a perceiver's own attitudes and beliefs (projection), judging someone on the basis of one's perception of the group to which that person belongs (stereotyping), causing a person to act erroneously on the basis of another person's perception (Pygmalion effect), or controlling another person's perception of oneself (impression management).

Strategic Communication

Strategic communication is an intentional process of presenting ideas in a clear, concise, and persuasive way. To plan strategic communication, managers must develop a methodology for thinking through and effectively communicating with superiors, staff, and peers. Sperry and Whiteman (2003) provide us with a strategic communication plan, which consists of five components. 1.Outcome: The specific result that an individual wants to achieve. 2.Context: The organizational importance of the communication. 3.Messages: The key information that staff need to know. 4.Tactical Reinforcement: Tactics or methods used to reinforce the message. 5.Feedback: The way the message is received and its impact on the individual, team, unit, or organization. Strategic communication requires forethought about the purpose and outcome of the message. Managers must be able to link the needs of the staff to the organization's mission and deadlines.

ICE Index of Communication Effectiveness

The ICE is a percentage of the reaction to the intended message over the total number of messages sent. If managers find that their ICE is low over time, they should evaluate their communication processes to identify ways to make improvements (Certo, 1992). Research suggests that to improve healthcare organizational communication and cohesion, exchanges between employees and leaders should involve leaders' direct support and encouragement of employees' constructive expressions of dissatisfaction and innovative ideas (Sobo and Sadler, 2002) (see Case Study 4-2: What Should We Do Now?). Index of communication effectiveness (ICE)= RIM (reaction to intended message) / TMS (total number of messages sent)

Managerial Grid

The Managerial Grid is based upon the assertion that one best leadership style exists. The Managerial Grid provides the manager with a conceptual assessment as to what his or her current leadership style is and, theoretically, provides an avenue of development in becoming an ideal manager. Although there is a possibility of being categorized in one of 81 possible positions on the grid, we will examine five positions on the grid to assist our understanding of the Managerial Grid. The Managerial Grid (see Figure 9-2) identifies a vertical axis, on a scale from one to nine, describing a concern for people. A horizontal axis, also on a scale from one to nine, identifies a concern for production. The five notable positions are the: impoverished manager (1,1); task manager (9,1); middle-of-the-road manager (5,5); country club manager (1,9); and ideal manager (9,9).

Employee Selection

The goals of selection are: (1) identify the knowledge, skills, abilities, and qualities necessary to perform a job well, (2) design tests to measure applicants' levels on those key job requirements, (3) administer and score the tests, and (4) determine the applicants most suitable for a given position, ensuring that the process is accurate and fair and does not discriminate against members of protected groups The basis for this employee selection process is the ability to identify key invariant qualities of individuals (such as skills, character, motivation, attitude, leadership potential, and personality) that match up well with the demands of the position and the culture of the organization.

Tannenbaum and Schmidt Continuum of Leadership Behavior

The model identifies the amount of authority (boss-centered) used by the manager and the amount of freedom afforded to employees (subordinate-centered). The appropriateness of the behavior is dependent upon situational (contingent) factors. One approach is not preferred over the other. The situational factors will determine appropriateness. Given appropriate time to seek involvement in a decision, the subordinate-centered approach is preferred for obvious reasons. Employees who are permitted to participate in the decision-making process most often are less threatened by the impending change by feeling more a part of the solution rather than as an observer who has no control over what may or may not happen.

Theory X and Theory Y

Theory X states that employees are unintelligent and lazy. They dislike work, avoiding it whenever possible. In addition, employees should be closely controlled because they have little desire for responsibility, have little aptitude for creativity in solving organizational problems, and will resist change. In contrast, Theory Y states that employees are creative and competent; they want meaningful work; they want to contribute; and they want to participate in decision-making and leadership functions.

cross-cultural communication

To achieve effective communication, healthcare professionals can apply several strategies to reduce communication barriers. Thiederman (1996) provides us with several verbal and nonverbal techniques to improve cross-cultural communication. •Write down in simple English the issues that have been agreed upon in order to obtain feedback on accuracy. •Repeat a message when there is doubt. •Watch for nonverbal signs of a lack of understanding. •Listen carefully to an entire message, especially when there is a foreign accent involved in the communication. •Create a relaxed atmosphere so that tension is reduced to increase the flow of communication. •Phrase questions in different ways to make it easier for the receiver to understand. To be effective in cross-cultural communication, several guidelines are important. •Understand one's own identity. To develop sensitivity to other cultures, you must first understand your own culture and identity. Your personal identity encompasses who you are and who you want to be. That is, you choose your lifestyle, goals, occupation or profession, and friends. The choices that you make or pursue are affected by racial, cultural, gender, and social class factors. •Enhance personal and social interactions. With globalization, we have increased opportunities to associate and develop close interactions with individuals who are different from us. The conscious decisions we make to become more accommodating, flexible, and tolerant of others broaden our views of the world and enrich our perspectives. Our relationships with those of different cultures help us to learn more about the world and to break typical stereotypes. These interactions also enable us to develop new skills for communicating with others and to learn from them. •Solve misunderstandings, miscommunications, and mistrust. Take the time and make the effort to study, understand, and appreciate individuals of different cultures. Through open, honest, and positive communication, this will resolve misunderstandings, miscommunications, and mistrust. •Enhance and enrich the quality of the work environment. Recognizing and respecting ethnic and cultural diversity through more open communication are the first steps toward valuing diversity and enriching the quality of the work environment (Hybels and Weaver, 2007).

Health Care Integration

To deal with these changes, we have seen a number of healthcare organizations restructure themselves into integrated delivery networks, which may be part of a local, regional, or national system. We have seen increased vertical, horizontal, and virtual integration.

Organizational Politics

Types of political behavior Attacking or Blaming Others: Attacking or blaming others is often associated with scapegoating—blaming others for a problem or failure. It may also include trying to make a rival look bad by minimizing his or her accomplishments. •Using Information as a Political Tool: Using information as a political tool may include withholding important information when doing so might further an employee's political interests. This type of behavior can also include information overload, for example, to bury or obscure important (but potentially damaging) details that the employee hopes go unnoticed. •Creating and Maintaining a Favorable Image: Creating and maintaining a favorable image includes drawing attention to one's successes and the successes of others, creating the appearance of being a player in the organization, and developing a reputation of possessing qualities considered to be important to the organization (i.e., impression management; see Chapter 3). The behavior also includes taking credit for the ideas and accomplishments of others. •Developing a Base of Support: Examples of developing a base of support include getting prior support for a decision before a meeting is called and getting others to contribute to an idea to secure their commitment. •Ingratiation/Praising Others: Ingratiation/praising includes praising others and establishing good rapport for self-serving purposes. Organizational jargon for this behavior includes buttering up the boss, apple polishing, and brown nosing. •Developing Allies and Forming Power Coalitions: Developing allies and forming power coalitions includes developing networks of coworkers, colleagues, and/or friends within and outside the organization for purposes of supporting or advocating a specific course of action. •Associating with Influential People: Associating with influential people includes developing professional connections with organizations and people that are known to be powerful individuals. Creating Obligations and Reciprocity: Creating obligations and reciprocity includes performing favors to create obligations from others. (You scratch my back, I'll scratch yours.)

Employee vs Production Centered

University of Michigan were also conducting research in an attempt to determine the most effective style of leadership based on two dimensions of leadership behavior: an employee-centered focus or a production-centered focus. Employee-centered leaders emphasized interpersonal relations, took a personal interest in the needs of their subordinates, and accepted individual differences among members. Production-centered leaders emphasized the technical aspects of the job, focused on accomplishing the tasks, and saw the members as a means to an end, that is, achievement of the tasks. The researchers found that general supervision (i.e., providing support and direction without being autocratic) created higher levels of productivity than did production-centered supervision and that low-producing supervisors placed an emphasis on production, displaying little concern for their employees. Years of research have confirmed the University of Michigan studies (Luthans, 2002). A particular note of interest from these studies was that productivity was not directly related to employee satisfaction. In addition, effective managers set specific goals, but gave employees freedom in the way they achieved those goals (i.e., empowerment).

Directional Flows of Communication

Upward communication occurs between supervisors and subordinates. The purposes of upward communication flow are to provide managers with information to make decisions, identify problem areas, collect data for performance assessments, determine staff morale, and reveal employee thoughts and feelings about the organization. -Grievance Procedure: The grievance procedure allows employees to make an appeal upward beyond their immediate supervisor. It protects individuals from arbitrary action by their direct supervisor and encourages communication about complaints. •Open-Door Policy: The supervisor's door is always open to subordinates. It is an invitation for subordinates to come in and talk to the supervisor about problems that trouble them, seek advice, or to share information. •Counseling, Questionnaires, and Exit Interviews: The department of human resources in a healthcare organization can facilitate subordinateinitiated communication by conducting confidential counseling, administering attitude questionnaires, and holding exit interviews for those leaving the organization. Information gained from these forms of communication can be used to make improvements. •Participative Decision-Making Techniques: Through the use of informal involvement of subordinates or formal participation programs such as qualityimprovement teams, union-management committees, and suggestion boxes, participative techniques can improve employee performance and satisfaction. Since employees can participate in the decision-making process, they feel that they can make valuable contributions to the organization. •Ombudsperson: The use of an ombudsperson provides an outlet for persons who feel they have been treated unfairly. Downward communication primarily involves passing on information from supervisors to subordinates. Downward communications include meeting with employees, written memos, newsletters, bulletin boards, procedural manuals, and clinical and administration information systems. Horizontal flow is from manager to manager or from coworker to coworker. For example, coordinating the continuum of patient care requires communication among multiple units. Committees, task forces, and cross-functional project teams are all useful forms of horizontal communication. Diagonal flow occurs between different levels of different departments. For example, diagonal communication occurs when the director of nursing asks the data analyst in the medical records department to generate a monthly report for all patients in the intensive care unit

Communication channels

Verbal and nonverbal face-to-face meetings have the highest information-carrying capability, because the sender can use verbal and nonverbal communication channels and the receiver can provide instant feedback. Choosing one communication channel over another lends meaning to the message. That is to say, there is symbolic meaning to the selection of a particular channel of communication beyond the message content. For example, when a manager tells an employee that they must have a face-to-face meeting, this symbolizes that the issue is important compared to a brief e-mail message with instructions. In summary, one essential part of the communication process is selecting an ideal channel of communication. The use of different channels leads to differences in the amount and variety of information transmitted.

Stereotyping

a conventional image applied to whole groups of people, and the treatment of groups according to a fixed set of generalized traits or characteristics. In addition to stereotyping racial and ethnic minorities, healthcare professionals have a tendency to stereotype other groups, such as the elderly, homeless, disabled, and those suffering from obesity One of the most common forms of stereotyping is on the issue of gender and leadership. Women hold positions at all levels within healthcare organizations, but as noted in Chapter 2, only between 10 and 13 percent hold chief executive officer positions. (See case of Ann Hopkins.) A recent study by Frank and his colleagues (2007) found that mandatory diversity training programs developed by companies to avoid liability in discrimination lawsuits were ineffective for increasing diversity in management. However, when diversity training is voluntary and undertaken to advance a company's business goals (and part of the organization's culture), it was associated with increased diversity in management. According to the study, it appears that employees don't react well when "sensitivity" training is forced on them!

Johari Window

a visual representation of the parts of yourself that are known to you and known to others. Window panes 1- known to self and other 2- known to others, not self 3- known to self, not others 4 - unknown / not yet occurred In the Johari Window, Luft (1984) argues for increasing the open area so that you and your coworkers are aware of your limitations. This is done by receiving more feedback from others and decreasing one's blind area (windowpane 2), and reducing the hidden area (windowpane 3) through disclosing more about oneself. The combination of feedback and disclosure may also help to produce more information in the unknown area (windowpane 4). The Johari Window can be used for opening channels of communication. Open communication is important for improving employee morale and increasing worker productivity.

cognitive dissonance

any incompatibility or inconsistency between attitudes or between behavior and attitudes. As an example, Harry likes two coworkers, John and Mary, but John does not like Mary (i.e., inconsistency). Harry needs to eliminate the inconsistency. Harry may: (1) try to change John's feelings toward Mary, (2) change his feelings about either John or Mary, or (3) sever his relationship with either John or Mary.

Personality Traits

are the regularities that we observe in someone's behavior, attitudes, and expressions. Prior research suggests that virtually all personality measures can be reduced or categorized under the Five-factor Model of Personality, also known as the "Big 5." The dimensionality of the Big 5 has been found to be applicable across all cultures. The Big 5 is based on the concept that personality can be described and measured on five broad dimensions and/or traits: openness, conscientiousness, extraversion, agreeableness, and neuroticism.

Horn effect (They're bad at one thing, they must be bad at other things too.)

attributing a variety of negative qualities to those you dislike. Opposite to the halo effect is the horn effect, whereby a person evaluates another as low on many traits because of a belief that the individual is low on one trait that is assumed to be critical.

Projection

attribution of one's own attitudes and beliefs onto others. All of us are guilty of unconsciously projecting our own beliefs onto others.

Leadership theories

earlier studies in leadership, referred to as the trait and behavioral theories in ch 9, laid the foundation for the leadership theories described in Chapter 10 (contingency theories) and Chapter 11 (contemporary or transformational theories).

Employee surveys

employee surveys have been widely used in organizations to obtain information about workers' attitudes toward their environments. This information is helpful for healthcare managers to determine whether management is "doing the right things" for retaining and motivating employees. organizations need to be cautious regarding the design of employee surveys to ensure that problem areas are not overlooked. Employee-attitude surveys are usually designed using 5-point Likert-type ("strongly agree-strongly disagree") or frequency ("never-very often") response formats. Content •Ask questions about observable behavior rather than thoughts or motives. •Include some items that can be independently verified. •Measure only behaviors that have a recognized link to your company's performance. Format •Keep sections of the survey unlabeled and uninterrupted by page breaks. •Design sections to contain a similar number of items, and questions with a similar number of words. •Place questions about respondent demographics last in employee surveys but first in performance appraisals. Measurement •Create a response scale with numbers at regularly spaced intervals and words only at each end. •If possible, use a response scale that asks respondents to estimate a frequency. •Use only one response scale that offers an odd number of options. •Avoid questions that require rankings. Administration •Make workplace surveys individually anonymous and demonstrate that they remain so. •In large organizations, make the department the primary unit of analysis for company surveys. •Make sure that employees can complete the survey in about 20 minutes. SOURCE: Getting the truth into workplace surveys, by P. Morrel-Samuels, 2002, Harvard Business Review, 80(2), pp. 111-118.

Sources of Power

five bases or sources of social power: reward power, coercive power, legitimate power, referent power, and expert power. Reward power is defined as the ability to give rewards, something that holds value to another individual. Coercive power is defined as the ability to punish either by administering a punishment or by withholding something that an individual needs or wants. Legitimate power is authority given to an individual on the basis of a given role or position. Expert power exists when A person awards power to another on the basis of their perception of the other's knowledge within a given area. Referent power stems from one person's affective regard (i.e., attraction) for, or identification with, the person of potential power.

4 ways managers have been successful in developing a power base

four ways managers have been successful in developing a power base. •Creating a Sense of Obligation: Managers will go out of their way to do favors for people whom they expect will feel an obligation to return those favors. •Building a Reputation as an Expert in a Certain Area: Managers will establish themselves as experts so that others will defer to them on those matters. This can be accomplished through visible achievement (i.e., professional reputation and track record). •Identification: Managers will try to foster others' unconscious identification with them or ideas they stand for. Managers try to look and behave in ways that others respect. They go out of their way to be visible to their employees and give speeches about their organization's goals, values, and so on. •Perceived Dependence: Managers will attempt to have others believe that they are dependent on the manager, either for help or not being hurt. The manager can accomplish this by securing resources that another person requires to perform his or her job. At the same time, the manager makes it known that he or she can also have the same resources removed. Managers may also resort to influencing others' perception of the manager's available resources, which may be more than, in reality, he or she possesses. In trying to influence people's judgments, managers pay attention to the trappings of power and to their own reputations and images. They associate with people and organizations that are known to be powerful. managers who build their power based on perceived expertise or on identification can often use it to influence attitudes as well as someone's immediate behavior, which would result in a lasting impact.

Skills of HC Management

healthcare managers need to possess the skills to communicate effectively with, motivate, and lead diverse groups of people within a large, dynamic, and complex industry. Managers need to understand the causes of workplace problems, such as low performance, turnover, conflict, and stress, so that they may be proactive and minimize these unnecessary negative outcomes.

Pygmalion Effect (expect more, get more)

higher expectations lead to an increase in performance The Pygmalion effect, or self-fulfilling prophecy, describes a person's behavior that is consistent with another individual's perception whether or not it is accurate. In other words, once an expectation is made known by another person, an individual will have the tendency to behave in ways consistent with the expectation. This can have negative or positive results. In other words, what a manager communicates as the expectation is what will result.

Impression Management (Relates to why people hide their mistakes.)

impression management, where people try to shape another's impression of themselves. Impression management incorporates what we do, how we do it, what we say, and how we say it as we try to influence the perceptions others have of us. Individuals will try to present themselves in ways that will lead to positive evaluations by others by highlighting their achievements and avoiding the disclosure of failures

Managers, Communication, & External Stakeholders

managers must be competent communicators, because they spend most of their time and energy communicating with large numbers of external stakeholders, individuals, groups, and organizations that are interested in the healthcare organization's actions and decisions. A competent communicator is an individual who has the ability to identify appropriate communication patterns in a given situation and to achieve goals by applying that knowledge. Competent communicators quickly learn the meaning that listeners take from certain words and symbols, and they know which communication channel is preferred in a particular situation. Moreover, competent communicators use this knowledge to communicate in ways to achieve personal, team, and organizational objectives. To competently communicate with external stakeholders, organizations and their managers are responsible for assessing the environment to gain information in order to make strategic decisions. Managers must utilize their roles as liaisons and monitors to scan the environment for opportunities and minimize threats. Furthermore, managers must utilize their strategist role to formulate and implement policies that are consistent with their organization's strategic goals and plans (Guo, 2003). Exhibit 4-3 shows steps for analyzing stakeholders to increase the acquisition of useful information. First, scanning the macro- and microenvironments results in information about stakeholders. In the case of one state's department of health, shown in Figure 4-7, the diversity of stakeholders is illustrated (Ginter et al., 1998). Relationships between the organization and its external stakeholders are complex and affect communication since the organization is a dynamic, open system operating in a turbulent external environment. The size and variety of external stakeholders make communication complex, especially since stakeholders attempt to influence the decision making of organizations. Fottler et al. (1989) examined communication between a large hospital and its stakeholders and found different relationships. While some relationships are positive, others are neutral or negative. Positive relationships with external stakeholders are easier to manage, and communication tends to be more effective than negative relationships. In the stakeholder analysis, important issues and stakeholders are identified through the environmental scan. Next, monitoring the activities of stakeholders is crucial. Managers must be able to take the views of stakeholders and use that information to incorporate trends into their decision-making process. Finally, managers must evaluate the value of the information, and take the information gathered and transmit it to those who need the information. Stakeholder Analysis 1.Scan the environment of the organization (macroenvironment: economic, regulatory, social/cultural, political, demographics, competitive, technology) (microenvironment: healthcare industry) 2.Identify strategically important issues (i.e., identify important stakeholders) 3.Monitor these issues (track stakeholders' views and positions) 4.Forecast trends (project trends in stakeholders' views and positions) 5.Assess their importance (assess the implications of stakeholders' views and positions) 6.Diffuse information (diffuse stakeholder information to those who need it)

Halo Effect (They're good at one thing, they must be good at other things too!)

occurs when an individual draws a general impression about another person based on a single characteristic, such as intelligence, sociability, or appearance. applicable to individuals' perceptions of others and of organizations. For example, a hospital that is well known for its open-heart and cardiac programs may be perceived in the community as excellent in other clinical areas such as obstetrics or orthopedics whether proven that is to be true or not.

Contrast Effect

relate to an individual's evaluation of another person's characteristics based on (or affected by) comparisons with other people who rank higher or lower on the same characteristics.

Hawthorne Studies

researchers discovered that workers were not isolated, unrelated individuals; they were social beings and their attitudes toward change in the workplace were based upon (1) the personal social conditioning (values, hopes, fears, expectations, etc.) they brought to the workplace, formed from their previous family or group associations, and (2) the human satisfaction the employee derived from his or her social participation with coworkers and supervisors. As such, the researchers learned that an employee's expression of dissatisfaction may be a symptom of an underlying problem on the job, at home, or in the person's past.

Reasons managers fail

stem from difficulty in handling change, not being able to work well in teams, and poor interpersonal relations.

Hawthorne effect

the tendency for people to behave differently when they know they are being studied

Influence Tactics for upward influence

•Assertiveness includes such influence tactics as demanding compliance, ordering, and setting deadlines, as well as nagging and expressing anger. •Ingratiation includes behaviors such as praising, politely asking, acting humble, making the other person feel important, and acting friendly. •The rationality tactic consists of using reason, logic, and compromise in attempting to influence others. This also includes attempts to convince others that certain actions are in their own best interests. •The exchange category refers to such behavior as offering to help others in exchange for reciprocal favors. •Upward appeal is indicated by behavioral attempts to gain support from superiors in an organization. •Coalition formation refers to attempts to build alliances with others.