MANAGEMENT IN HEALTH CARE A Theoretical and Experiential Approach Elaine Lynne La Monica EdD FAAN Professor of Nursing Education Teachers College, Columbia University, New York and Consultant in Management for Health Care Additional material for the Macmillan adaptation by Philip Jan Morgan, BA Hons MA PhD Lecturer in Human Resource Management Cardiff Business School, University of Wales College of Cardiff * © Springer Publishing Company, Inc. 1990 Adaptations for Macmillan edition IC> Philip I. Morgan 1994 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The authors have asserted their rights to be identified as the authors of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 1990 by Springer Publishing Company, Inc. 536 Broadway New York, NY 10012 under the title Management in Nursing: An Experimental Approach That Makes Theory Work For You Written by Elaine Lynne La Monica Published by PALGRAVE MACMILLAN Houndmills, Basingstoke, Hampshire RG21 6XS and 175 Fifth Avenue, New York. N.Y. 10010 Companies and representatives throughout the world PALGRAVE MACMILLAN is the global academic imprint of the Palgrave Macmillan division of St. Martin's Press, LLC and of Palgrave Macmillan Ltd. Macmillan~ is a registered trademark in the United States, United Kingdom and other countries. Palgrave is a registered trademark in the European Union and other countries. ISBN 978-0-333-56386-1 ISBN 978-1-349-23156-0 (eBook) DOI 10.1007/978-1-349-23156-0 This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. A catalogue record for this book is available from the British Library. 11 10 9 B 7 6 5 08 07 06 OS 04 03 Dedicated to My best friend, Robert S. Rigolosi For feeling without saying And For saying with feeling ... Always .... Elaine Lynne La Monica Elaine L. La Monica, EdD, FAAN, is Professor of Nursing Education at Teachers College, Columbia University, New York. Currently, she is also Director of the Institute of Research and Service in Nursing Education. Her formal education includes a Doctor of Education degree in human relations and counseling from the School of Education, University of Massachusetts, Amherst; a Masters of Nursing in medical and surgical nursing administration from the College of Nursing, University of Florida, Gainesville; and a Bachelor of Science in nursing from Columbia Union College, Takoma Park, Maryland. In addition to administrative and academic responsibilities at Teachers College, Dr La Monica maintains a private consulting practice in management for health care organizations and other public and private industries throughout the US, Canada and overseas. She also conducts training programmes on organizational behaviour both nationally and internationally. Scholarly activities included serving as the Management Briefs Editor for The Journal of Nursing Administration and as a frequent author on management, empathy, and related topics in professional journals. Dr La Monica's most recent books are Nursing Leadership and Management: An Experiential Approach, 1986, and The Humanistic Nursing Process, 1985; both are published by Jones and Bartlett, Boston, Massachusetts. The La Monica Empathy Profile, 1986, published by XICOM, Inc., Sterling Forest, Tuxedo, New York, is an instrument for measuring empathy in helpers-teachers, nurses, managers, and other care givers. Dr La Monica maintains membership in the following professional organizations: American Academy of Nursing, American Nurses Associ ation, American Psychological Association, New York State Nurses Association, and Sigma Theta Tau-Alpha Theta Chapter, an honour society for nurses. This book is an adaptation of Management in Nursing: An Experiential Approach That Makes Theory Work For You, solely authored by Dr Elaine La Monica, and published by Springer Publishing Company, New York, 1990. Philip I. Morgan, PhD, MA, BA(Hons), is a lecturer in Human Resource Management at Cardiff Business School, University of Wales. His formal education included a BA with Honours in Business Administration from Strathclyde University and doctoral studies at The Ohio State University. Dr Morgan has taught management subjects at universities in the US and the UK at postgraduate and undergraduate levels. In addition to teaching and academic responsibilities, he researches, lectures, and con sults for various public and private organizations, including various hospitals in the UK. His research interests include Organisational Devel opment and Total Quality Management issues related to the National Health Service. Dr Morgan's additions to Dr Elaine L. La Monica's book are identified by footnotes, as are the chapters of which he is the sole author. Acknowledgments Even though the author first imagined and then created this book, the theory, exercises, and philosophy represented have been derived from many personal and professional resources. Some materials are original, and some are from established sources to whom credit is most gratefully given; others have evolved from an interchange with professionals and learners whose commitment has been to quality. I would like particularly to thank Donald Carew, Kenneth Blanchard, and Paul Hersey, whose teachings and writings were the foundation of my doctoral education and are the cornerstones of my current professional activities; Frederic Finch for sharing his knowledge; Phil Graf for his reinforcement and assist ance-for believing many years ago that I had something to offer future managers; and my colleagues in education and practice for the constant interchange that has shaped today. To all who have moulded my beliefs, to all from whom I have received, I express my sincere gratitude. Elaine Lynne La Monica vi Preface It is widely recognized that health care professionals must become ef fective managers and leaders in order to fulfil their responsibilities to themselves, to their clients, and to the professions. Practice environments, roles, and educational programmes are expanding. There is an actual and projected decline in the numbers entering the professions; there is an actual and projected need for increased professional services'due to chang ing demographics of the population and crises emanating from disease states. Other trends in health care include (a) changing emphases imposed by federal and state cost-containment regulations; (b) changing and alternative methods for health care delivery; (c) increasing focus on health maintenance-primary care-in addition to the ever-present foci on sec ondary care and tertiary care; and (d) greater quantities of data to support the mind/body relationship in health and disease, suggesting that not only is cure important, but altering behaviours is crucial so that the need to cure may be unnecessary or less frequent. Wherever their placement in the health care arena, health care managers will be leaders of themselves; of colleagues and peers in inter disciplinary clinical teams, of technicians and other health care providers; of colleagues in various management levels within formal health care organizations; of the public sector through media; of the individual clients, in city, state, national, and international political entities, and so forth. In these placements, they will be called upon for creative strategies, disciplined and cost-contained programmes, and the abilities to research and analyse systems critically and chart growth-all in response to rapid health care changes. It is therefore mandatory that professionals perceive themselves in the roles of managers and leaders and increase their know ledge and application of theory and research in practice so that quality, comprehensive, efficient care is provided to clients in any setting. Leadership and management involve processes that are essential in making any health care role, in any environment, alive. Disciplines and professions such as organizational behaviour, educational administration, and business have developed theories that assist managers in increasing the probability of achieving specified goals. Managers must apply these vii viii Preface theories into leadership and management, and then extend them into theory through research. Responsibility and authority granted by a practice act, an institution, an individual's unique experience and person ality, and one's personal philosophy on the constituents of quality care and effective management, must be integrated with knowledge and an ability to apply existing theories of management in health care practice. This book covers the processes of management and leadership in health care practices. It evolves from my experience in teaching future managers of health care personnel in the delivery of care. Content focuses on increasing organizational effectiveness in service and practice. The ories and concepts from the professions of business, organizational psychology, and educational administration are applied to topics in each chapter. Sections of the book include simulations (for example, case presenta tions and multimedia activities) to provide practice experiences that illustrate the content of the chapters, as well as to expand the learner's range of experience. The simulations comprise the experiential approach; they provide learners with an opportunity to observe, experience, and carry out new behaviours in a safe, low-risk practice environment. Careful explanations are provided for each simulation. The textbook and exercises are designed for use both in self-learning and classroom environments, in both individual and group learning experiences. It is suggested that study be weighted so that more time is devoted to the experiential elements, since enriched learning in management is derived more from actual and vicarious experiences than from reading and studying the printed word. This book is written primarily for undergraduate students in health care management and leadership courses. It is also intended as a resource for graduate administration students, practitioners, learners in inservice and continuing education programmes, and faculty. It is a pleasure to have Dr Morgan's additions in the Macmillan version of this book and to have had the opportunity to work with Dr Morgan on the adaptation. Elaine Lynne La Monica Introduction Management and leadership in health care involve an individual's efforts to influence the behaviour of others in providing direct, individualized, professional care. The basic premise of management is that managers set goals that represent some level of growth for a particular group in a particular environment. Managers then develop strategies for reaching these goals. Results are evaluated and altered or new directions are set. There is no value of good or bad to the actual state of the group, the group's goals, or the outcomes. Managers simply and constantly design strategies for moving groups of personnel to more efficient and more qualitative levels of functioning. The actual beginning points and the end points are of lesser importance than is the process of constantly develop ing strategies that result in identifiable, effective, and positive growth. In conducting these processes, managers plan, organize, motivate, and con trol the work of other allied health care personnel in the delivery of professional care. The processes of management and leadership are based on a scientific approach called the problem-solving method. The function of this scientific method is to increase the probability of success for a manager's actions, given the particulars of a unique environment. In a typical health care environment, there are staff members, clients, managers, situational variables such as policies and norms, and material resources; these are unique since it would be impossible to find this exact environment in another place or time. The goal of the manager is to identify the environ ment's resources and to put them to work as a whole system in accom plishing goals and facilitating growth. Use of the scientific method in management simply assists the manager in assessing many needs of the system and in choosing the priorities, identifying the people and situational elements that are important in carrying out specified goals, critically assessing the strengths of those people, and developing strategies that put those strengths to work. A manager can be functional in the role without using the problem solving method. This alternative, called "seat-of-the-pants" management, evolves from following only impulses and personal beliefs about self and others. Such management comes from involuntary behaviours that do not ix