RS MGMT Chapter 3 Leadership Concepts in Health Information Management
Cultural Diversity
Patient satisfaction is impacted when patients see their community represented in the workforce of the local hospitals and healthcare facilities. Professional interpreters and multilingual staff are used to enhance patient and family communication. A multicultural organization is attractive to a diverse talent pool of individuals. Employees with different backgrounds and beliefs provide added value to organizational decision-making and, as such, impact overall performance and idea generation. Diverse employees bring their own perspective to an organization, and offer different viewpoints, experiences, and insights into management discussions.
Equity Theory
The equity theory of motivation suggests that employees are motivated by the balance of their inputs in relation to their outputs as compared to both their employer and other workers. In other words, an employee is motivated to do well when they believe what they contribute to a job in the way of effort, skills, loyalty, and trust (inputs) is equally matched by what they receive from a job in the way of salary, benefits, recognition, and job security (outputs). An employee who perceives an inequity between inputs and outputs will try to correct the imbalance by reducing productivity, increasing absenteeism, or even separating from the organization.
Teams
The evidence of diversity within an organization is no more apparent than in its teams. A team is a group of people working together to achieve a common goal for which they hold themselves accountable. In a team: • Members work toward a common purpose • The end product could not be completed without people working together; the tasks depend on a team effort • Members share responsibility for the outcome or end product • Members respect the necessity of working together to accomplish the common goal • Members engage in team activities that cross departmental boundaries within an organization With the proliferation of quality improvement projects in healthcare, teams have become a popular way to improve outcomes and reduce costs. Teams may offer -employees an opportunity for job enrichment or autonomy. -reduce the workload of a department supervisor. -create a team when the proposed work is too cumbersome or complex for an individual. When forming a team, it is important to first have a clear sense of the team's purpose or goal. Ideally, a team's goal or output is clearly connected to the organization's strategic plan, mission, and vision. There is no point in moving a team forward if the outcomes have no impact on the organization's strategic plan. This generally means that team members must be granted the time, technology, financial resources, and supporting staff necessary to serve on a team. Team members need to know that their routine work responsibilities will be covered in their absence, or the thought of the work piling up and waiting can be a distraction. Teams also need access to the right communication tools to function. (ex. Data-sharing technology) A functional team might also require financial resources in order to meet goals. -A budget provided to the team at the beginning of their project helps to ensure financial resources are adequate and managed wisely. The team's statement of purpose must be clear as to their levels of authority and access so that all people involved in the team's efforts understand the limits placed on the team. Team members must be confident that they have enough decision-making power to accomplish their goals. In addition, a team needs access to data to make decisions. Team members need to spend sufficient time with the necessary stakeholders to become informed and be granted access to the necessary data to aid in decision-making.
Goal-setting Theory
The goal-setting theory is based on the premise that employees respond best when goals are clearly defined and feedback is provided about goal progress. -The positive impact of the goal-setting theory on employee motivation is found in the employee's commitment to the goals that have been set. -Goals must be challenging yet attainable. -Goals must also be specific rather than vague. (Example: a goal to "code as accurately as possible" is not specific. A goal of "an abstracting accuracy rate of 80 percent" is specific and attainable) Positive work performance results when goals are developed by the employee or assigned by a supervisor. Regular feedback on the progress toward achieving goals is also an important component of the goal-setting theory.
Reinforcement Theory
The reinforcement theory of motivation is built on the incentive and reward concept. -Employees are motivated to perform in relation to incentives or positive reinforcement as well as disincentives or negative reinforcement. -In operant conditioning, behavior is associated with a positive or negative reward and is modified or learned over time. For example, when an employee exhibits a desired behavior and positive reinforcement is given for that behavior, over time the employee is more likely to repeat the desired behavior as she or he learns to associate the behavior with the positive reinforcement. Conversely, behaviors that are associated with negative reinforcement will not be repeated. Examples of positive reinforcement can be expensive: promotions, bonuses, Negative reinforcement most often takes the form of criticism or punishment. It is important to note that for the reward (or punishment) to be effective as a motivator, the employee must see value in the reward or punishment. It also helps for the reinforcement to be given as close to the desired behavior as possible. A performance bonus will not be as effective if given at the end of the year as it would be if the bonus appeared on the next paycheck Transcriptionists are paid by the line or report, and coders are paid by the number of records coded.
Virtual Teams
Virtual teams are teams whose members are geographically distributed, requiring them to work together through electronic means with minimal face-to-face contact. Geographic differences may mean an increase in the diversity of team members. Virtual teams rely on information sharing (shared websites, intranets) and communication technology (email, video conferencing or teleconferencing, or webinars) to accomplish their work.
There are different kinds of teams:
formal and informal, cross-functional, and virtual.
Cross-Functional Teams (or interdisciplinary teams)
made up of members from different departments. Cross-functional teams work best when the problem to be addressed requires input from different sources. In some cases, it is unlikely that one department would have the knowledge and resources necessary to resolve all issues. (ex. implementation of a clinical documentation improvement plan would require representation from various departments throughout a healthcare organization) Keep in mind that members of an interdisciplinary team still have responsibilities and work to do in their home departments. This might lead to loyalty and prioritization issues. It may also mean that team members are not happy to be assigned to a team when they know they have work waiting for them when they return to their departments. In a cross-functional setting, the team leader will not have direct authority over all team members, so care must be used in assigning tasks, motivating members to perform, and making decisions.
The following 10 factors affect employee motivation:
• Interesting work • Good wages • Full appreciation of work done • Job security • Good working conditions • Promotions and growth in the organization • Feeling of being in on things • Personal loyalty to employees • Tactful discipline • Sympathetic help with personal problems
Success factors for virtual teams include the following:
•Establish trust. Trust develops over time in face-to-face interactions, but this is not an option for virtual teams. Trust in virtual teams is developed through the actions and demonstrated abilities of team members. • Support diversity. Geographic differences mean that language and cultural differences may be more present than in the traditional workplace. Diversity in work styles and decision-making styles is another obstacle for virtual teams to overcome. • Communicate. Virtual teams need technology tools to communicate. Training may be necessary so all members know how and when to use technology. Interpersonal communication skills must also be in place. Simple things such as greeting members by name and checking in with silent members might be taken for granted in a face-to-face setting but need to be consciously managed in a virtual setting. "Netiquette" rules (etiquette for virtual communication) for both email and video or teleconferencing should be reviewed so there is no confusion or offense in regular communication. • Create clear goals. This is an important success factor for any team, but the unique issue of asynchronous communication may lead to confusion or misunderstanding of stated goals and their intent. Progress toward meeting goals should be highlighted on a regular basis so that all team members remain focused and knowledgeable about the process. • Recognize team members. Periodic reports to each individual team member's supervisor recognize contributions made by individuals. Virtual team members need to feel that their input is important to the success of the outcomes. Virtual reward ceremonies can be held as recognition at the conclusion of a team's tenure.
Teams come together to perform the necessary work to meet their assigned outcomes. There are four stages of team growth:
1. Forming: Team members are established, tasks defined, and behaviors and ground rules are outlined 2. Storming: Team members work together to learn to effectively manage differences of opinions and outright conflict so collaboration can occur and move the project forward 3. Norming: Team members make progress on their work, overcoming differences and accepting the established ground rules 4. Performing: Team members perform consistently to get the work done, choosing and implementing changes and working through group problems.
Maslow's Hierarchy of Needs
Abraham Maslow's theory puts forth the idea that individuals are motivated based on a hierarchy of needs. As each need is met, the individual moves to the next level in an attempt to satisfy the next need. Physiological Needs: Food, Water, Shelter Safety and Security: Health, Employment, Family Love and Belonging: Friendship, Sense of Connection Self-Esteem: Achievement, Respect of Others Self-Actualization: Creativity, Personal Fulfillment page 58
Once team members are chosen, it is important to remember that as work progresses it is possible to change the membership composition.
After a time, certain team members may no longer be relevant to the task, or it may be necessary to invite others with specific knowledge or insight to join the team, if only for a few meetings.
Inclusion
All organizations are diverse, but not all organizations are inclusive. Inclusion means that the differences between individuals are truly respected and valued in the workplace. Inclusion is the result of successful diversity management and enables all employees, regardless of aspects like age, gender, race, or religion, to be as productive as possible. Accepting diversity and valuing the contributions of all employees is necessary for an organization to reach its potential.
Other motivational strategies center on redesigning job descriptions.
Job design changes are used to motivate employees by making their jobs more interesting and increasing an individual's usefulness throughout the organization. Job enlargement is a horizontal expansion of an employee's duties. Tasks are added to the current job, but employees have the same degree of autonomy and responsibility. (example: adding outpatient coding to an inpatient coding position; no new skill sets are required, but additional training in Current Procedural Terminology (CPT) would be provided.) Job enrichment is a vertical expansion of a person's duties. Generally, a new skill set is required, and responsibility and autonomy are increased. (example: requiring clinical documentation specialists to prepare and present documentation tips and query examples to physicians at monthly medical and surgical department meetings.) Job rotation requires employees to rotate among different tasks or jobs, usually at the same level. Employees learn new job tasks and job rotation offers a break from the monotony of a repetitive job.
Motivation Strategies
Knowledge of motivational theories is applied in the workplace by managers when they develop strategies and techniques to influence employee behavior. One motivational theory cannot be applied across the board in any department. A manager must know which theory to apply, to whom to apply it, and in what situations the theory will work best. The key to developing motivational strategies for the workplace is communication. Motivation strategies that use these 10 factors as their focus will be more successful. For employees who respond to the reinforcement theory of motivation, incentive pay programs may be most effective as a motivating strategy. Programs such as profit sharing and stock ownership by employees, even though initiated by senior management and offered to the entire organization, also tie compensation directly to company performance and give employees positive reinforcement for their efforts A strategy for employees who respond to the goal-setting theory of motivation involves the employee in both setting goals and determining the actions necessary for completing the goals.
Aging Workforce Motivation
Later in a career, extrinsic rewards such as promotion and pay increases may not be as attractive and may be replaced by intrinsic desires for job security or positive interpersonal relationships in the workplace. More mature workers may respond to the opportunity to share their accumulated knowledge and experience with younger workers in the form of mentoring or team building.
Diversity Management
A hospital with a diversity improvement plan: • Has a nondiscrimination policy that includes ethnic, racial, lesbian, gay, bisexual, transgender, and transsexual communities • Educates all clinical staff during orientation about how to address the unique cultural and linguistic factors affecting the care of diverse patients and communities • Collaborates with other healthcare organizations to improve professional and allied healthcare workforce training and educational programs in the communities served • Requires all employees to attend diversity training • Has implemented a program that identifies diverse, talented employees within the organization for promotion • Has a documented plan to recruit and retain a diverse workforce that reflects the organization's patient population • Hiring managers have a diversity goal in their performance expectations (Institute for Diversity in Health Management 2015) Employee affinity groups are a way for social groups to come together in the workplace. -Affinity groups are formed by employees with common interests. They come together for a specific purpose such as mentoring, continuing education, or participation in a service project. (resource groups for employee groups such as Asians; Blacks; people with disabilities)
Formal versus Informal Teams
Formal teams are structured, assigned a charter, and usually proceed with meetings, minutes, and agendas. Formal teams can be short term, as in the case of planning for a department relocation, or long term, as evidenced by a hospital infection control committee. Informal teams consist of employees who develop groups around shared interests that may or may not pertain to organizational business. -Managers need to be aware of such teams, as they can have a positive or negative impact on morale or lead to union activity. -On an informal team, there is no team sponsor. -informal teams do have leaders, either self-appointed or appointed by the group.
Herzberg's Two-Factor Theory (motivation-hygiene theory)
Herzberg identified two motivational elements—motivators (satisfiers) and hygiene factors (dissatisfiers). Motivators are elements that can provide job satisfaction to employees and consist of achievement, recognition, the work itself, advancement, and responsibility. Hygiene factors are elements that can provide job dissatisfaction to employees and consist of company policies, supervision, working conditions, and financial rewards. These items are not motivators but rather indicate whether an employee is happy or unhappy and can act as de-motivators. Theses two factors did not correlate with each other. improving working conditions might satisfy employees, but if there remains no opportunity for career advancement, they will not be motivated. see image page 60
Morale
Morale is "the mental and emotional condition (as of enthusiasm, confidence, or loyalty) of an individual or group with regard to the function or tasks at hand" There is a positive relationship between morale and productivity, although the effects diminish as morale increases. Increasing low morale to a moderate or high level can increase productivity. However, employees that already exhibit high levels of morale probably cannot increase their productivity measurably. morale is higher when there are positive feelings about an organization and management. When there is low morale, employees are more likely to distrust changes and treat them as threats to their job security or pay. When there is high morale, employees are more likely to view changes as benefits to both their job and the organization. Workplace safety is another component affecting employee morale. (example: Universal precautions protect against disease transmission) The degree to which employees are encouraged to participate in safety programs can be perceived as a measure of how much an organization values its workforce. Workplace safety is also affected when employees themselves create an unsafe environment. Morale-boosting efforts should focus on creating a positive atmosphere in the workplace. Managers can show genuine appreciation for their employees in many ways. -Department social gatherings such as picnics and recognition dinners held off-site can boost morale. -Routine efforts such as handwritten thank you notes, public recognition of professional achievements, and afternoon treats can be less expensive ways to help build positive feelings about the workplace. As managers develop morale-boosting programs, it is important to remember that expensive measures to impact morale come at a cost to the organization and can negate any productivity gains.
Work Motivation Theories
Motivation is based on both intrinsic and extrinsic elements. Intrinsic (or internal) motivating factors come from within the individual. -There may be an inner drive to succeed or an intangible feeling of accomplishment in a job done well. Extrinsic (or external) motivating factors are tangible and obvious to others. -Extrinsic factors might include a promotion or a salary increase. Motivation is a highly personal topic What motivates an employee at the start of their career does not necessarily continue to motivate after 20 years on the job. What motivates one employee may not motivate a different employee doing the same type of work. An effective HIM manager will work to understand the motivating factors for each individual employee. HIM managers need to communicate with employees to know which elements matter most to the individual. Work motivation theories are not a one-size-fits-all solution to performance and productivity issues.
Motivation
Motivational theory is a topic with which HIM professionals need to be familiar in order to begin to understand what makes employees behave as they do. Motivation is "the forces acting on or within a person that cause the person to behave in a specific, goal-directed manner". Understanding employee behavior helps the manager to influence and improve performance using motivation techniques. A functional organization requires its employees to successfully complete their work tasks, and motivation is the individual drive that leads to task accomplishment.
Aging Workforce cont'd
Stereotyping accompanies age diversity in the workplace. Typical negative stereotypes related to older workers are that they are not as productive as younger workers, they have more health issues, and they are not as flexible or receptive to change as younger workers. Leadership is responsible for setting a tone of appreciation for both the experience(s) of older workers and the new ideas that younger workers provide. Acceptance, collaboration, and appreciation for differences must exist in an organization and be reinforced at all levels in order to combat these stereotypes. Offering continuing training and learning opportunities to all employees, regardless of age, helps to debunk the stereotype that "you can't teach an old dog new tricks." Recognition of the senior coders' expertise in reviewing charts, knowledge obtained in anatomy and physiology, and understanding of individual physician documentation patterns should be highlighted and ways to transfer this knowledge to newer coders developed. A positive organizational mindset allows for changes in policies and procedures related to retirement. -retirement issues become greater in importance and programs designed to help employees with retirement decisions can be offered. -For example, older employees may be allowed to phase into retirement with reduced work hours. a phased approach allows time for older workers to impart their knowledge gained from experience to younger workers. Bridge employment is a job that an individual takes between leaving their full-time position and beginning full-time retirement. The job could be part-time in the same organization or in the same field, part-time in a new field, self-employment, or even temporary work. -Bridge employment allows a new retiree to transition mentally and physically into full-time retirement status. -Bridge employment also provides an economic cushion for those individuals worried about their financial situation in retirement.
Members of the Team
Team roles are assigned so that the work of the team can get done in a timely and effective manner. The team sponsor is the individual who initially brings the team together and assigns their charter. - The sponsor oversees the work of the team: selecting members, making sure the team moves in the right direction and has the resources they need to function, and supporting team efforts across the organization. The team charter clearly defines the expectations of the team, details the mission and vision of the team, provides the scope, sets the boundaries, names the leader and members, and identifies the key outcomes. The team sponsor is usually a member of the executive or management level and does not participate in actual team meetings. On a formal team, the team leader is usually selected by the sponsor, although team members may have input. The team leader is responsible for the administrative aspects of team management like setting and running meetings, assigning tasks, keeping the team focused, resolving conflicts among members, communicating with the team sponsor, and making sure that the resources are being used efficiently. Team members do the work of the team such as participating in discussions, putting forth ideas, sharing solutions, carrying out assigned tasks, and supporting team actions in their individual work areas. Team members may also perform the additional roles of recorder and timekeeper. The recorder creates a meeting agenda, takes and distributes meeting minutes, helps to create charts, and sends out necessary correspondence. The timekeeper is responsible for keeping meetings on track by managing time. The timekeeper tells all members how much time has been spent on a topic and if too much time is being spent on a particular agenda item. Many formal teams also have a team facilitator, or coach, who is present at meetings but is neither the leader nor a member. -The facilitator understands the team process and is available to assist with the mechanics of the team process, but he or she is not as concerned with the outcome of the project as much as they are concerned that the team functions productively. -The facilitator provides coaching on how to run a meeting, assign tasks, and make decisions.
Motivating Teams
What motivates an individual to improve performance is different than what motivates a team. Teams must work together to achieve common rather than individual goals. In fact, individual goals may conflict with group goals. Managers should consider the impact of social identity when motivating teams. However, a negative perspective is illustrated when a merger of departments takes place. Employees may not want to surrender their previous identity, and their performance could decline as a result. When motivating virtual teams, it is necessary to create a social identity for the team. This gives people who do not normally work together, or even know each other, a sense of commonality and lessens their reliance on their identity as an individual. The idea of social identity also applies to choosing a team leader. Team members are more apt to be motivated by a leader who shares their perceived social identity. The team leader should be seen as part of the group rather than a separate entity. Another way to motivate teams is to compare the performance of teams to one another.
Barriers to Increasing Diversity in the Healthcare Environment
minorities are underrepresented in healthcare organization board rooms and executive offices. Barriers to improving workplace diversity are both psychological and organizational psychological barriers include similarity-attraction, social identity, stereotyping, and cognitive biases. Similarity-attraction means that, overall, people prefer to interact with others who are similar to themselves. When given a choice, people prefer to spend time with others whose attitudes and values are like their own. Social identity is a person's sense of belonging to a social group. -Membership in a social group maintains an individual's self-image. -As a result, a person belonging to a particular social group is more likely to discriminate against someone belonging to a different social group. -Social groups also practice stereotyping and exhibit cultural bias. Stereotypes are generalizations about individuals based on their identity, group membership, or affiliations Cognitive bias is commonly defined as an error in reasoning, judgment, or decision-making. (Ex. bandwagon effect) bandwagon effect when they do something simply because other people are doing it; it's popular or a fad. Social groups rely on locating new members that represent their current social group. New ideas presented by employees with different values and beliefs may not be accepted by the organization and, therefore, the employees are reluctant to present them. retention can be a barrier to diversity. Work-life balance issues may also be barriers to creating a diverse workforce. Employees at all levels of an organization strive to maintain a balance between their work and personal life. Organizations can address work-life balance issues by offering a variety of benefits to employees. -Flexible scheduling allows for flextime (adjusting arrival and departure times) and compressed work weeks. -Compressed work weeks allow employees to work a 40-hour week in three or four longer days rather than over five straight days. -Job sharing among employees creates options for part-time work. -Technological advancements open the door to remote work being done from almost any location the employee may choose. The extent to which an organization tolerates harassment and exclusion is another barrier to diversity. -The Civil Rights Act of 1964 specifically prohibits discrimination in hiring, compensation, and training on the basis of race, religion, gender, national origin, disability, or sexual orientation. Harassment and exclusion promote a hostile work environment that leads to employee dissatisfaction, decreased performance, and increased turnover.
There are formal and informal teams, cross-functional teams, and virtual teams;
the purpose of each type of team is defined so managers understand when teams are appropriate for use in the healthcare workplace.
Workplace diversity
the set of individual, group, and cultural differences employees bring to an organization Individual differences refer to the abilities, skills, and qualifications people bring to the workplace and are represented by demographic elements such as race, age, and gender. Physical ability and sexual orientation are also individual differences Cultural differences are found in an individual's or group's values, beliefs, religion, language, and behaviors. Respondents report that diverse leadership is an important business tool for their organizations: 72 percent believe that cultural diversity enhances the equity of patient care, 71 percent believe that it supports successful decision-making, and 66 percent believe that diversity in recruiting contributes to reaching organizational strategic goals Results from these surveys indicate there is a disconnect between the perceived value of diversity in the workplace and the actual presence of diversity in the workplace in healthcare. (Institute for Diversity in Health Management (an affiliate of the American Hospital Association)) Leaders in healthcare may believe that diversity leads to patient satisfaction and improves successful decision-making, but the lack of minorities on hospital boards and in management positions indicates that there is little minority representation in decision-making positions in hospitals.
Aging Workforce
workers age 55 and older are expected to make up a larger share of the labor force than in the past The actual and projected statistics indicate that at the same time the older workforce is growing, the younger workforce is declining Financial reasons, such as the need for money or health insurance, also keep this age of worker employed as people discover that their personal assets and savings will not last long in an extended retirement. The lack of younger workers to replace retiring workers may also cause older workers to remain in the workplace for a longer period Actionable areas include focusing on human resource services, combating stereotyping, improving transfer of knowledge from seasoned workers to new workers, and creating solutions for retirement options. Implementing flexible work practices such as staggered start times and job sharing improves retention of older employees who might be struggling with issues related to care of elderly parents or young grandchildren. Organizations should offer health and wellness education tailored to an aging workforce. Physical and mental health issues should be addressed through routine health checks and wellness training. The physical work environment should be assessed for safety as well as ergonomic features that benefit all employees but have particular appeal to older individuals. (ex. adjustable workstations)
The following are best practices that contribute to the advancement of cultural competence at healthcare organizations.
• Create mentoring programs • Create programs or opportunities to expose young people to healthcare careers • Seek regular employee input about the organization's diversity initiatives • Create or expand internal diversity • Communicate the value of cultural differences to all employees
how to form a successful team:
• Ensure there is representation from all areas of the organization that are affected by the problem • Allow for diversity of perspectives • Pay attention to positive personal chemistry among team members • Create a team with a manageable size (for example, no more than 8 to 10 members) • Enlist members with a desire or interest to serve the purpose of the team • Choose a leader who collaborates, not dominates
There are many straightforward ways to promote effective behavior in a diverse work group:
• Explain acronyms prior to using them. An individual's socioeconomic or job status may limit his or her knowledge of acronyms. • Use idioms sparingly. Many idioms are used as metaphors to make an idea or a point more vivid; however, they may not be universally understood by all ethnic groups or may be perceived as insulting. • Expect employees not to use slang in the workplace. Slang is multicultural. Each group has its own words. • Ask individuals to speak more slowly if it will help others better understand what they are saying. • Explain motives for criticizing employees and choose words carefully. Focus constructive criticism on the employee's behavior, not the person. Include specific objective examples. The key is to criticize without crippling, allowing the employee to actively participate in correcting the behavior. • If it is necessary to correct an employee's grammar, do it privately and kindly. • Use friendly tones when talking to all ethnic groups; don't talk down to anyone. • Pay attention to body language. Respect others' personal space and keep an appropriate distance (4 to 12 feet). • Listen for what is not being said, especially in staff meetings. Be an active listener. • Encourage and invite people to talk in group settings.