Chapter 9 Building a Culture of ImprovementObje.docx
- 1. Chapter 9: Building a Culture of Improvement Objectives • Understand the meaning of organizational culture and indicators of organizational culture. • Be able to describe at least one way of classifying differences in national cultures. • Describe common but essential values of organizations in general and health organizations in particular: diversity, safety, learning, collaboration, and service. • Be able to discuss key strategies for culture change. Outline • Meaning of Organizational Culture • Indicators of Organizational Culture • Organizational Cultures in Health
- 2. • Strategies for Culture Change Meaning of Organizational Culture • Culture is “the way we do things around here.” • Culture can be applied to groups, communities, and entire societies. • Culture encompasses the assumptions, beliefs, values, and norms of an organization. Components of Culture • Values are the ideals, customs, and institutions of an organization that its members hold in high regard. • Social norms are expectations about behavior. • Assumptions and beliefs underlie an organization’s culture and often include the conviction that the organization is pursuing worthwhile ends—what is good for the organization is good for society How to Recognize Culture • Examine a range of activities, artifacts, and
- 3. behaviors. • This provides insights into details of its culture. • Use multiple measures because culture is broad and sometime internally inconsistent within organizations. Espoused Values • Espoused values are stated in an organization’s vision, mission, and value statements. • Often the organizational values reflect the opinions of decision-makers at the top of the formal hierarchy. • Espoused values are often formalized in the ethical guidelines of professions. • Many norms are enacted and transmitted informally through daily behavior. • Norms about such issues as length of breaks, dress, and attendance at social functions have to be learned informally. Symbols of Culture • Indirect manifestations of norms, values, beliefs, and assumptions.
- 4. • Examples include: – Specialized language – Rituals – Ceremonies – Physical artifacts such as logos Stories as a Symbol of Culture • Stories reflect important values. • Stories about an organization’s founder or past leaders are used to transmit important guidelines for attitudes and behavior. • Stories about heroic behavior, such as service during emergencies or difficult times, may promote the value of service to potential clients or customers. Four Types of Culture • Four groups: – Networked – Mercenary – Fragmented
- 5. – Communal Four Types of Culture • Classification is based on the degree to which workers share goals (solidarity) and the degree to which they are friends (sociability). • Fragmented cultures are lowest on both criteria. • Communal cultures are highest on both. • Managers can help cultures of organizations change over time based on external conditions. Organizational Cultures in Health • Some organizational values are particularly important in health. • Health organizations are beginning to develop expertise in cultural transformation. • They create cultures that emphasize: – Cultural diversity – Cross-understanding
- 6. – Safety – Learning Cultural Diversity • Diversity in the cultures of client or customer populations, and in an organization’s workforce, is a reality for most public health organizations. • Respect for cultural diversity is an imperative for effective organizational performance. • Respect for cultural diversity is a moral imperative for many people. • Five dimensions of cultures that distinguish residents of different countries from each other have been identified. Power Distance • Indicates the degree of equality among individuals. • High power distance ratings reflect cultures in which inequalities between people are accepted and perpetuated. • Employees are more likely to expect clear guidance from upper management, and the relationships between managers and workers
- 7. are rarely close and personal. Uncertainty Avoidance • Encompasses the extent to which people are comfortable with ambiguity and uncertainty. • More rule-oriented, with well-established laws, regulations, and controls. • Organizational change may be more difficult to achieve, and proposals for change will be examined in detail. • Individuals in countries that exhibit lower levels of uncertainty avoidance are more willing to take risks and accept change. Individualism • Reflects the importance of individuals versus collective populations. • Residents tend to have relationships with many other people, but the relationships are relatively weak. • More likely to express their own personalities at work, and individual rights such as freedom of speech are often brought into the workplace. • In more collectivist societies, ties between
- 8. individuals are very strong and the family is given more weight. Masculinity • The degree to which a culture emphasizes the traditional male work role model of ambition and achievement, versus caring and nurture. • Males tend to dominate the power structure more than in less masculine societies. • Workers are expected to sacrifice personal life for their jobs. • Communication style is more direct, concise, and impersonal. Long-Term Orientation • Indicates respect for long-standing traditions and values. • Showing respect for traditions, honoring social obligations, and avoiding loss of face are important in cultures with high levels of long- term orientation. • In cultures with low levels of long-term orientation, creativity and self-actualization are valued more.
- 9. Cross-Understanding • Provides a way for organizations to develop an appreciation for all types of employee differences, including cultural diversity. • The extent to which group members have an accurate understanding of one another’s mental models. • Group members are better able to anticipate the behavior of their colleagues and then adjust their own behavior. • Can be developed through self-awareness, shifting of perspective, and adaptation of new behavior. Culture of Safety • Health organization work includes interaction with clients in situations that can result in injury or death if safety is not a value. • Excellent guidelines for promoting cultures of safety are emerging in organizations that are committed to safe practices. • These include applying labels such as “cultures of safety” and “fair and just culture.”
- 10. Fair and Just Culture • One that learns and improves by openly identifying and examining its own weaknesses. • Employees feel they are supported and safe when voicing concerns. • Employees speak safely on issues regarding their own actions and the actions of others. • Employees seek help when concerned that the quality of the services being delivered are threatened. • Employees are comfortable monitoring others, detecting excessive workloads, and redistributing work. Culture of Safety • Continuously seeks to minimize harm to customers or clients that may result from the processes used to deliver goods, programs, or services. • Not acting when conditions are unsafe or safety protocols have been breached is unacceptable. • Teamwork and openness to innovation should be prominent values in the pursuit of organizational safety.
- 11. High-Reliability Organizations • Strive to maximize reliability of organizational operations and services when the consequences of error can be disastrous. • Establishing and maintaining an underlying high reliability structure constitutes an organizational commitment to values and behaviors that increase reliability, improve responses to surprises, and reduce the probability of errors. High-Reliability Organizations (continued) • Creating a culture of mindfulness requires organizational commitment and infrastructure in at least four areas. – Commitment to mindfulness in their beliefs, values, and actions. – Commitment must be perceived by workers as being consistent rather than hypocritical. – Rewards flow toward those who act mindfully and away from those who do not. – Emphasize the need to “walk the talk.”
- 12. Learning • When learning is valued in an organization, workers improve processes and structures in the fields for which they have been trained. • Learning organizations create and capture knowledge, disseminate it to all employees, and apply it in their products and services • The value of learning through scientific research and evidence is central to the mission of many health organizations. • Evidence-based management is a movement that attempts to promote the better use of scientific evidence in strategic and operational decision-making. Collaboration and Service • Teamwork and collaboration are synergistic when both occur simultaneously. – Teamwork is sharing duties and responsibilities. – Collaboration is sharing knowledge and information. • Promoting service as a cultural value requires managers that model, recognize, and reward workers who deliver high quality service. • These organizational leaders must convey passion and inspiration through stories, presentations from consumers, and publicly recognizing consumer service
- 13. heroes and heroines. Strategies for Culture Change • Implementing new cultures requires both a commitment to goals and hard work. • Three strategies to change culture: – Enthusiastic support of top management – Use rewards, incentives, and public recognition – Consideration of terminating or moving those who are uncomfortable with the new culture Chapter 8: Organizing Human Resources Objectives • Understand the recruitment process. • Know key issues of compensation and benefits. • Be better able to retain valued employees.
- 14. • Understand the importance of training and developing employees. • Have knowledge about identifying problem employees. Outline • Ongoing Responsibilities of Human Resources • Legal Considerations and Responsibilities • Recruitment • Compensation and Benefits • Retaining Valued Employees • Training and Developing Employees • Problem Employees Ongoing Responsibilities of Human Resources • Creating and maintaining position descriptions • Recruiting • Union activities
- 15. • Employee training • Employee problems • Documentation Important Federal Statutes • Social Security Act (1935) • Fair Labor Standards Act (1938) • Equal Pay Act (1963) • Civil Rights Act (1964) • Age Discrimination in Employment Act (1967) Important Federal Statutes (continued) • Employee Retirement Income Security Act (1974) • Consolidated Omnibus Budget Reconciliation Act (1986) • Americans with Disabilities Act (1990) • Family and Medical Leave Act (1993) • Health Insurance Portability and Accountability Act (1996)
- 16. Recruitment Within an Organization • Word of mouth is generally quite informal and unscientific, but may be efficient for small organizations. • Many employers advertise positions through job postings. • Employers generally post positions internally for 5 to 7 working days before initiating external recruitment. • Current employees may be a good source of referrals for new workers. • Some employers offer bonuses for successful employee referrals. Recruitment Outside an Organization • Two types of employment agencies: – State employment agencies and union referral halls (free) – Private employment agencies (agency fee) • Private employment agencies will screen and interview candidates prior to referring them to an organization. • Employment agency’s fee is generally paid by the new employer.
- 17. Ways to Recruitment On Your Own • Organizations such as professional societies or special interest groups provide referrals. • Use the internet. – Open to a wide range of applicants – Continuously available – Less expensive • Contact local colleges and universities for internship programs Screening Candidates • Determine the key qualifications for the position. • Keep detailed records about the process, make notes about people who are retained in the pool as well as those who are rejected during the initial screening. • Reasons for inclusion or exclusion from an initial pool should be noted.
- 18. Preparing for the Interview • The purpose of an interview is to determine the suitability and fit of an applicant for the open position. • Review the current position description. • Prepare a list of basic questions to ask all applicants. • Read each applicant’s resume. Interviewing a Candidate • Ways to conduct an interview: – Unstructured – Semi-structured – Group interviews • Set the interviewee at ease. • Ask innocent but open-ended questions to encourage interviewees to talk. • Honestly describe the position and the organization. • Ask if the interviewee has any questions about the potential job or organization. Selecting Candidates • Once a candidate has been selected, agree on pay,
- 19. complete paperwork, and set a start date. • Employment is usually contingent upon several points: – Legal age to work? – Does the person have permission to work in the United States? – Can the applicant pass minimum physical requirements for the job? – Is the candidate able to pass a medical examination including drug and alcohol screening tests if these are used? What Are Compensation and Benefits? • While money provides considerable motivation, other factors provide more motivation. • Direct compensation refers to salaries, bonuses, and other forms of incentive pay. • Indirect compensation refers to employee benefits and perquisites, items that employees typically receive in forms other than cash payments. • Health workers typically are motivated to serve the public as well. Direct Compensation
- 20. • Develop a base-salary compensation program. • General increases reflect satisfactory completion of work responsibilities. • Incentive plans are intended to reward outstanding performance. • External equity means that rates of pay in an organization are reasonable compared with other similar positions in a given area for people performing the same or similar job duties. • Internal equity means that all employees think that their pay is fair when compared to others with the same job title in the same organization. Benefits • Benefits fall into two categories: – Benefits required by statutes. – Benefits to attract and retain the best employees. • Two approaches to benefits: – Defined benefit plans provide the same package of benefits to all employees. – Defined contribution plans allocate a fixed amount of money for benefits and provide a list of benefit options.
- 21. Required Benefits • Social Security has expanded from a form of basic pension coverage for about 50 percent of the workforce to a full-scale social insurance program available to more than 90 percent of the population. • Unemployment compensation insurance is administered by individual states. • Workers’ compensation insurance is intended to provide health care, income maintenance, and survivor protection for employees who become disabled or killed due to an occupational injury or illness. Optional Benefits • Health insurance plans provide various forms of health coverage. • Paid Time Off (PTO) plans where employees accumulate an allotted number of days and then use them in a more discretionary manner. • Long-term disability insurance is a benefit designed to protect employees from the devastation of serious illness or accident. • Life insurance provides employees with a level of coverage equal to some multiple of their annual compensation.
- 22. • Employee retirement plans include benefit and contribution plans. Retaining Valued Employees • Valued employees can be given special assignments that provide variety as well as allowing them to demonstrate their readiness for promotion. • Valued employees can serve as mentors, allowing them to learn or practice supervisory skills. • Organizations that ignore their valued employees run a risk of losing them due to boredom, stagnation, or loss of morale. • All managers have a responsibility to identify and develop new managers, which helps retain valuable employees by giving them opportunities to grow as leaders. Training and Developing Employees • Managers eliminate training and development when budgets become tight. • Have a new employee orientation plan. • When performance does not meet expectations, supervisors may consider additional training. • Cross training is defined as learning how to do one or
- 23. more jobs normally performed by other persons. • On-the-job training is occasionally appropriate. • Inappropriate training is to give employees files or folders to review, or to direct them to a website. Problem Employees • Mental problems can interfere with work and job duties. • Three relatively common mental health problems include chemical dependency, depression, and abuse. • Physical and sexual abuse are common in the United States. • Managers are reminded not to attempt providing therapy. Identifying Personality Disorders • Four common personality disorders: – Narcissistic – Borderline – Histrionic
- 24. – Paranoid Identifying Personality Disorders • Common characteristics to all four include: – Difficulties with relationships and lack empathy – Very rigid and cannot easily accept ideas of others – Boundary problems cause them to disregard procedures, protocols, and organizational chains of command Narcissistic Personality Disorder • Tend to think very highly of themselves, often exaggerating their achievements and talents beyond their actual real abilities. • They love to be in the limelight and may steal ideas and take credit for the accomplishments of others. • They often demonstrate excessive self-promotion and attention-seeking behavior. • Difficulty accepting other points of view. • Feel little loyalty to either supervisors or employers. • Strategies include giving employees credit for their accomplishments, avoiding challenges, and not taking their criticism personally.
- 25. Borderline Personality Disorder • Most common personality problem in the workplace. • Very intense and tend to have frequent outbursts of temper. • They can become physically abusive. • Their relationships tend to be dramatic and turbulent. • These employees are prone to extreme mood swings ranging from cheerful and cooperative to angry and abusive. • Difficulty distinguishing between personal and professional relationships. • Useful strategies include not getting caught up in their personal problems and minimizing interactions. Histrionic Personality Disorder • Appear to be in a constant state of crisis. • Their personal lives often overflow into the workplace. • Tend to be overly dramatic and pull anyone willing to listen or be used by them into their world. • They are usually very engaging and seductive. • Upon first meeting them, most people like them. • Take days off on a whim. • See themselves as victims.
- 26. • Expect special treatment for missing work. • Useful strategies include staying calm and not giving in to their demands. Paranoid Personality Disorder • They are suspicious of others. • Combative in their interactions with others, rigid, and critical of coworkers but unable to accept criticism. • Harmless remarks can cause them to threaten legal action. • Useful strategies include not giving constructive feedback since it will be perceived as criticism, not teasing them, and not assigning them to positions or projects that require collaborative work relationships. Instead, they should be placed in positions where they can work independently. Progressive Discipline Model Chapter 7: Managing Organizational Dynamics
- 27. Objectives • Understand the strength of informal groups. • Appreciate the nature and structure of informal channels of communication. • Know how to work with informal groups in occupational settings. • Apply organizational theory to resolving conflict. • Apply organizational politics to increase organizational effectiveness. Outline • Informal Groups • Conflict • Power and Politics • Other Ways to Influence Organizational Dynamics What Is an Informal Group? • Informal groups are often peer groups that exist within most formal organizations.
- 28. • They have their own norms for status and prestige. • Peer groups provide four benefits: 1. Satisfy complex needs 2. Offer emotional support 3. Help shape personal identities 4. Assist in meeting personal goals How Informal Groups Are Formed • Physical closeness and a chance to communicate must exist before people can form mutually satisfying groups. • Groups begin with friendships based on contacts at work, equipment used, or common interests. • Once these groups are established, they develop lives of their own. • The process is dynamic and self-generating. Group Identification • Members of professional groups differentiate themselves with signs of group membership.
- 29. – Physicians display stethoscopes around their necks. – Nurses wear nursing school pins. – Members use professional jargon. Status in Groups • Two classes of factors are relevant to status: • External: attributes brought from the outside – Age, gender, race, education, and seniority • Internal: created when senior management establishes and defines an organization – Titles, job descriptions, perquisites, work schedules, and offices Managing Informal Groups • Managers experience difficulties when the goals or structures of the formal organization conflict with those of informal groups. – Occurs when management’s evaluation of positions does not correspond with group member opinions. • Managers must select between two positions.
- 30. – Rearrange the formal organization to accommodate the desires of an informal group. – Change the composition of the informal group. Types of Conflict • Three distinct types of conflict are of interest to professional managers: – Interpersonal – Intergroup – Specialist versus generalist • Conflict can be constructive Interpersonal Conflict • Interpersonal conflict is the least important but most exaggerated type of friction. • Managers often blame organizational problems on individual personalities or general worker incompetence. • Poorly structured formal channels of communication frequently contribute to interpersonal conflict.
- 31. • Individuals resent communications that flow in only one direction. Intergroup Conflict • Intergroup conflict develops when clusters of employees belonging to different informal groups must interact with each other. • Apathetic groups are least likely to exert concentrated pressure on management. • Erratic groups display inconsistent behavior towards management. • Strategic groups tend to be shrewd and calculating when applying pressure. • Conservative groups are composed of elite members who are secure and powerful. Pressure on Groups • When organizations exert pressure on employees, lateral communication among peers tends to increase. • Concurrently, vertical communications between different levels of management tend to decrease. • Personal differences among group members are minimized when presented with the threat of a
- 32. common danger such as a tough supervisor. • Strong management policies toward workers may encourage the formation of strong informal groups to resist the pressure. Specialist Versus Generalist • Specialist: advanced skills and specific knowledge • Generalist: knows something about many positions but not enough to displace a specialist – Uses means other than technical knowledge to succeed, which results in relying on subordinates – Subordinates are unable to go to their supervisor for assistance with technical problems, which leads to resentment and feelings that the boss is incompetent. Constructive Conflict • Conflict can be a constructive force in organizational life. • Suppressing conflict can create a significant barrier to improvement. • If employees (and managers) fear retribution for delivering bad news or correcting their superiors, opportunities will be missed.
- 33. 5 Methods of Conflict Management • Compromise requires each side to give up something for a solution that is not ideal for either party but is best for the organization. • Collaboration is ideas that appeal to both parties. • Competition is letting both sides battle to resolve a disagreement, with the most powerful winning. • Accommodation is when one side surrenders. • Avoidance is when both sides let conflict fester. Power and Politics • Organizational politics involves the use of power to get things done. • Power derives from formal authority, control over resources, expertise, and certain personal characteristics and social networks of individuals. Power from Formal Authority • Authority is a system in which a small number of
- 34. individuals make decisions for many people. • Authority is deep seated, and often thought to be innate to individuals and organizations. • Decisions are made using two guidelines: – Standing policies: long-lived and may affect many people – Ad hoc rules: either an interpretation of existing (standing) policies or is made because no explicit guidelines exist. Power from Informal Authority • Individuals emerge as informal leaders because group members accept their suggestions. • Leaders may be accepted due to their charisma or their relationships with powerful others. • Leaders can be accepted through wisdom or judgment acquired from previous successful decisions or leadership experiences (expertise). Reward and Punishment • Managers control rewards and punishments that can be dispensed to influence employees’ behavior in a positive manner.
- 35. • Positive rewards make individuals feel good • Negative rewards (sanctions) tend to be given along a continuum of increasing degrees of coercion with repeated applications. Constructive Politics • Constructive politics can be used in organizations to move controversial issues to decision points and to advance the agenda of the organization. • Constructive politics means using power in ways that are moral, open, and caring. • Managers can use politics to help achieve organizational goals by setting agendas, anticipating resistance, networking and building coalitions, and bargaining and negotiating. Other Ways to Influence Organizational Dynamics • Behavioral changes can be achieved by taking direct action or working with political channels. • Effective managers motivate employees to think about problems before they occur. • Managers understand the dynamics of groups and their rules of behavior.
- 36. • Change may also involve altering the existing formal structure of an organization. Other Ways to Influence Organizational Dynamics (continued) • Effective managers spend a significant amount of time responding to subordinates. • Planning and modifying the structure and flow of work to minimize stress or factors that deter effective performance is important. • Managers do not to routinely expect levels of production they would be unwilling or unable to produce themselves.